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Methtrexate Neurotoxicity
Case Detail
| Anatomy: Brain-Spine |
 Joseph Junewick, MD FACR |
| Diagnostic Category: Infectious-Inflammatory |
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| Created: 9 months ago |
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| Updated: 9 months ago |
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| Tags:
PEDS
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| Modality/Study Types:
MR
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Activities:  PDF  ImageJA |
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.