title: Posterior reversible encephalopathy syndrome associated with methotrexate neurotoxicity: conventional magnetic resonance and diffusion-weighted imaging findings.
abstract: The addition of intrathecal methotrexate to treatment protocols has increased survival rates in children with acute lymphoblastic leukemia but is also associated with varying degrees of neurotoxicity. We describe a 15-year-old female patient diagnosed with acute lymphoblastic leukemia presenting with status epilepticus after receiving intrathecal methotrexate. Magnetic resonance imaging showed reversible cortical and subcortical changes consisting of high-intensity lesions on T2-weighted and fluid-attenuated inversion recovery sequences with postgadolinium enhancement, low signal intensity on diffusion-weighted imaging and increased apparent diffusion coefficient. These findings were consistent with the posterior reversible encephalopathy syndrome. We report our conventional magnetic resonance and diffusion-weighted imaging findings and briefly discuss the pathophysiology of the syndrome.
authors.affiliation: Department of Neuroradiology, University Hospital, Bari, Italy.
authors.forename: Franca
authors.initials: F
authors.lastname: Dicuonzo
authors.forename: Andrea
authors.initials: A
authors.lastname: Salvati
authors.forename: Michele
authors.initials: M
authors.lastname: Palma
authors.forename: Velia
authors.initials: V
authors.lastname: Lefons
authors.forename: Giovanni
authors.initials: G
authors.lastname: Lasalandra
authors.forename: Francesco
authors.initials: F
authors.lastname: De Leonardis
authors.forename: Nicola
authors.initials: N
authors.lastname: Santoro
mesh_terms: D000293:Adolescent; D000964:Antimetabolites, Antineoplastic / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D001921:Brain / Q000098:blood supply / Q000187:drug effects / Q000473:pathology; D001927:Brain Diseases / Q000139:chemically induced* / Q000473:pathology*; D038524:Diffusion Magnetic Resonance Imaging; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007278:Injections, Spinal; D008279:Magnetic Resonance Imaging; D008727:Methotrexate / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D010690:Phlebography; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000188:drug therapy; D013226:Status Epilepticus / Q000139:chemically induced* / Q000473:pathology*; D013577:Syndrome
chemical_list: D000964:Antimetabolites, Antineoplastic; D008727:Methotrexate