Clinical and MRI characteristics of levamisole-induced leukoencephalopathy in 16 patients

J Neuroimaging. 2009 Oct;19(4):326-31. doi: 10.1111/j.1552-6569.2008.00344.x. Epub 2009 Jan 29.


Objective: To study the clinical and radiological characteristics of levamisole-induced leukoencephalopathy (LILE) in patients with recurrent aphthous ulcers (RAU) or infected with Ascaris.

Methods: The medical histories of 16 patients with LILE were analyzed, including clinical manifestations, brain magnetic resonance imaging (MRI) characteristics, cerebrospinal fluid, and brain biopsy findings.

Results: The main clinical manifestations of LILE were motor weakness (75.0%), dysphasia or aphasia (50.0%), cognitive disorder (50.0%), and facial palsy (43.8%). The MRI of 16 cases showed plaque and round or oval demyelinating lesions in white matter, which revealed a signal hypointensity on T1-weighted and diffusion-weighted images (DWI), and demonstrated hyperintensity on T2-weighted and fluid-attenuated inversion recovery (FLAIR) images. The MRI revealed peripheral ring-type enhancement about the focus after Gd-DTPA administration and edema around some lesions, without mass effect. T2-weighted and FLAIR images were highly sensitive to the lesions. Brain biopsy in 1 patient showed multifocal demyelinating lesions without perivascular cuffing by lymphocytes. Treatment generally consisted of steroids and hyperbaric oxygen therapy, and patients recovered to normal condition.

Conclusions: A single normal dose of levamisole can induce leukoencephalopathy in patients with RAU or Ascaris. The diagnosis depends on the clinical features and imaging appearances. Steroid therapy might be a good choice of treatment.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adjuvants, Immunologic / adverse effects*
  • Adolescent
  • Adult
  • Antinematodal Agents / adverse effects*
  • Ascariasis / drug therapy
  • Brain / drug effects
  • Brain / pathology*
  • Child
  • Demyelinating Diseases / chemically induced
  • Demyelinating Diseases / pathology
  • Diffusion Magnetic Resonance Imaging
  • Female
  • Humans
  • Leukoencephalopathies / chemically induced*
  • Leukoencephalopathies / pathology*
  • Levamisole / adverse effects*
  • Magnetic Resonance Imaging
  • Male
  • Middle Aged
  • Retrospective Studies
  • Stomatitis, Aphthous / drug therapy


  • Adjuvants, Immunologic
  • Antinematodal Agents
  • Levamisole