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Thalamic Infarct
Heather Borders, MD
over 5 years ago
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Methtrexate Neurotoxicity

Case Detail

Anatomy: Brain-Spine
Junewick
Joseph Junewick, MD FACR
Diagnostic Category: Infectious-Inflammatory
Created: over 6 years ago
Updated: over 6 years ago
Tags: PEDS
Modality/Study Types: MR
Activities:
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History

Teenage being treated for leukemia now with neurologic deterioration.


Case Images


Diagnosis

Methotrexate Neurotoxicity

Findings

MR – Bilateral symmetric nonenhancing T2 and FLAIR hyperintensities in the perilateral ventricular white matter; the centrum semiovale was involved on other images.

Discussion

Treatment-induced leukoencephalopathy is seen with fluorouracil, topotecan, cisplatin, cytarabine, carmustine, and thiotepa but is most common with methotrexate. The manifestations of acute neurotoxic effects include seizures, transient ischemic attacks, encephalopathy, ataxia, and myelopathy. Imaging findings show restricted diffusion acutely and gliosis and encephalomalacia chronicly. Neurotoxic effects are common with acute leukemia, particularly in younger children, higher doses and those undergoing radiation therapy Risk factors for methotrexate-induced neurotoxic effects include high-dose treatment, intrathecal treatment, young age, and associated cranial radiation therapy. Patients often recover spontaneously.

Reference

Vazquez E, Delgado I, Sanchez-Montanez A, et al. Side Effects of Oncologic Therapies in the Pediatric Central Nervous System: Update on Neuroimaging Findings. RadioGraphics (2011); 31: 1123-1139.



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