Neurotoxicity of intrathecal methotrexate: MR imaging findings.
We report a case of intrathecal methotrexate neurotoxicity manifesting as left arm weakness and aphasia. Diagnostic imaging showed restricted diffusion and fluid-attenuated inversion recovery imaging findings were normal at presentation. Three weeks later, diffusion abnormalities resolved, and T2-weighted studies showed increased signal intensity of prolonged T2 changes in areas of prior restricted diffusion. We attribute the clinical and radiographic findings to cytotoxic edema secondary to intrathecal methotrexate.
Sandoval
Claudio
C
Department of Pediatrics, New York Medical College, Valhalla, New York 10595, USA.
Kutscher
Martin
M
Jayabose
Somasundaram
S
Tenner
Michael
M
D000208:Acute Disease; D000293:Adolescent; D000964:Antimetabolites, Antineoplastic / Q000008:administration & dosage / Q000009:adverse effects*; D001921:Brain / Q000473:pathology; D001929:Brain Edema / Q000139:chemically induced; D038524:Diffusion Magnetic Resonance Imaging; D005260:Female; D006801:Humans; D007278:Injections, Spinal; D008727:Methotrexate / Q000008:administration & dosage / Q000009:adverse effects*; D020258:Neurotoxicity Syndromes / Q000209:etiology* / Q000473:pathology; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000188:drug therapy
D000964:Antimetabolites, Antineoplastic; D008727:Methotrexate