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Chemotherapy Associated Neurotoxicity
Case Detail
| Anatomy: Brain-Spine |
 Joseph Junewick, MD FACR |
| Diagnostic Category: Infectious-Inflammatory |
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| Created: over 4 years ago |
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| Updated: over 4 years ago |
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| Tags:
PEDS
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| Modality/Study Types:
MR
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Activities:  PDF  ImageJA |
History
Teenage female with ALL and seixure.
Case Images
Diagnosis
Chemotherapy Associated Neurotoxicity
Clinical Notes
Recent aspariginase and methotrexate therapy.
Findings
MR – Isotropic diffusion and apparent diffusion coefficient images show right greater than left frontal and parietal restricted diffusion.
Discussion
Seizure, transient ischemic attacks, encephalopathy, ataxia and/or myelopathy occur in 5-18% of patients being treated for acute lymphoblastic leukemia. Acute neurotoxicity is probably related to methotrexate, cytarabine, vincristine, aspariginase and/or steroids. Methotrexate is most often implicated and associated with high dose therapy, intrathecal administration, young age and irradiation. The centrum semiovale is most often affected. Pathophysiology is unclear but may be related to adenosine accumulation, homocysteine excitation of n-methyl-d-aspartate receptors and/or altered biopterin metabolism. Diffusion abnormalities precede T2 and T2-FLAIR signal disturbances. Despite restriction, recovery usually occurs, suggesting transient impairment of cell membrane handling of water.
Reference
Fisher MJ, Khademian ZP, Simon EM, et al. Diffusion weighted MR imaging of early methotrexate-related neurotoxicity in children. Am J Neuroradiol (2005); 26:1686-1689.