We report the case of a 17-yr-old man diagnosed as a toluene abuser. He had an 8-mo history of toluene inhalation exposure and was admitted to this hospital with symptoms of auditory and visual hallucination. Magnetic resonance imaging (MRI) revealed no structural abnormalities both on T1- and T2-weighted images, whereas SPECT using 99mTc-ethyl cysteinate dimer (ECD) showed multifocally decreased perfusion in the cerebral cortex, basal ganglia and thalami. Our case indicates that SPECT detects

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... arly central nervous system injury from toluene inhalation even when neurological examination and neuroanatomic imaging such as MRI are normal.