Fig. 8

Fludarabine-induced progressive multifocal leukoencephalopathy (PML). A 56-year-old man with chronic lymphocytic leukemia had received a high dose of oral fludarabine 40 mg/m2/d for 5 days every 4 weeks for eight cycles earlier, developed progressive weakness of his left arm and legs. Axial T1-weighted (a, b), T2-weighted (c, d), and FLAIR (e, f). MRI revealed low T1 and high T2 and FLAIR signal intensities in bilateral cerebral white matter particularly involving the subcortical U fibers (arrows) giving a scalloped appearance. These findings are consistent with PML secondary to Fludarabine neurotoxicity