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Desmoplastic Infantile Astrocytoma
Joseph Junewick, MD FACR
over 10 years ago
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Chemotherapy Associated Neurotoxicity

Case Detail

Anatomy: Brain-Spine
Joseph Junewick, MD FACR
Diagnostic Category: Infectious-Inflammatory
Created: over 7 years ago
Updated: over 7 years ago
Tags: PEDS
Modality/Study Types: MR
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Teenage female with ALL and seixure.

Case Images


Chemotherapy Associated Neurotoxicity

Clinical Notes

Recent aspariginase and methotrexate therapy.


MR – Isotropic diffusion and apparent diffusion coefficient images show right greater than left frontal and parietal restricted diffusion.


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.


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.

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