Neurotoxicity of Intrathecal Methotrexate: MR Imaging Findings

• Published in: American journal of neuroradiology : AJNR Vol. 24; no. 9; pp. 1887 - 1890
• Main Authors: Sandoval, Claudio, Kutscher, Martin, Jayabose, Somasundaram, Tenner, Michael
• Format: Journal Article
• Language: English
• Published: Oak Brook, IL Am Soc Neuroradiology 01.10.2003; American Society of Neuroradiology
• Subjects: Acute Disease; Adolescent; Antimetabolites, Antineoplastic - administration & dosage; Antimetabolites, Antineoplastic - adverse effects; Biological and medical sciences; Brain; Brain - pathology; Brain Edema - chemically induced; Diffusion Magnetic Resonance Imaging; Drug toxicity and drugs side effects treatment; Female; Hematologic and hematopoietic diseases; Humans; Injections, Spinal; Leukemias. Malignant lymphomas. Malignant reticulosis. Myelofibrosis; Medical sciences; Methotrexate - administration & dosage; Methotrexate - adverse effects; Neurotoxicity Syndromes - etiology; Neurotoxicity Syndromes - pathology; Pharmacology. Drug treatments; Precursor Cell Lymphoblastic Leukemia-Lymphoma - drug therapy; Toxicity: nervous system and muscle; Antineoplastic agent; Human; Nervous system diseases; Toxicity; Acute; Malignant hemopathy; Nuclear magnetic resonance imaging; Cerebral disorder; Case study; Chemotherapy; Lymphoproliferative syndrome; Central nervous system disease; Medical imagery; Acute lymphocytic leukemia; Methotrexate
• ISSN: 0195-6108; 1936-959X

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.