10-year-old female with acute lymphoblastic leukemia who had just finished the third cycle of intrathecal administration of methotrexate, presented with acute onset of right hemiparesis.
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There are focal and symmetrical regions of restricted diffusion on DWI images and ADC maps, seen on both centrum semiovale and splenium of corpus callosum. T2-weighted images show high signal intensity, while FLAIR shows mild ring hyperintensity. After gadolinium injection there is no enhancement of these lesions.
Clinical evolution and imaging findings suggest the presence of acute methotrexate-induced neurotoxicity.
- Claudio Sandoval, Martin Kutscher, Somasundaram Jayabose, Michael Tenner. Neurotoxicity of Intrathecal Methotrexate: MR Imaging Findings. American Journal of Neuroradiology. 24:1887–1890, October 2003.