title: Medication neurotoxicity in children.
abstract: Medication neurotoxicity may have a variety of imaging manifestations in children. In this pictorial essay, we review the two most common brain injury patterns, posterior reversible encephalopathy syndrome (PRES) and acute toxic leukoencephalopathy (ATL). Proposed etiologies, salient features on neurological imaging, and methods for differentiating these entities and their implications will be discussed. Certain agents do not fall into these two broad patterns but instead characteristically involve central structures. We individually review several medications and their respective neurotoxic appearances including methotrexate, cyclosporine A, tacrolimus, metronidazole and vigabatrin. Diagnosis of medication neurotoxicity may be achieved by the combination of new-onset neurological deficits, recent initiation of a new therapy agent and distinctive findings on magnetic resonance imaging. Clinical and radiological improvement and/or resolution are frequently observed after the agent is discontinued.
authors.affiliation: Department of Radiology, Seattle Children's Hospital, Seattle, WA 98105, USA. riyer@uw.edu
authors.forename: Ramesh S
authors.initials: RS
authors.lastname: Iyer
authors.forename: Apeksha
authors.initials: A
authors.lastname: Chaturvedi
authors.forename: Sumit
authors.initials: S
authors.lastname: Pruthi
authors.forename: Paritosh C
authors.initials: PC
authors.lastname: Khanna
authors.forename: Gisele E
authors.initials: GE
authors.lastname: Ishak
mesh_terms: D000293:Adolescent; D020533:Angiogenesis Inhibitors / Q000009:adverse effects; D000890:Anti-Infective Agents / Q000009:adverse effects; D061067:Antibodies, Monoclonal, Humanized / Q000009:adverse effects; D000068258:Bevacizumab; D002675:Child, Preschool; D016572:Cyclosporine / Q000009:adverse effects; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects; D007223:Infant; D008279:Magnetic Resonance Imaging; D008297:Male; D008727:Methotrexate / Q000009:adverse effects; D008795:Metronidazole / Q000009:adverse effects; D020258:Neurotoxicity Syndromes / Q000175:diagnosis* / Q000209:etiology*; D054038:Posterior Leukoencephalopathy Syndrome / Q000139:chemically induced / Q000175:diagnosis*; D016559:Tacrolimus / Q000009:adverse effects; D055815:Young Adult
chemical_list: D020533:Angiogenesis Inhibitors; D000890:Anti-Infective Agents; D061067:Antibodies, Monoclonal, Humanized; D007166:Immunosuppressive Agents; D008795:Metronidazole; D000068258:Bevacizumab; D016572:Cyclosporine; D016559:Tacrolimus; D008727:Methotrexate