Document Detail

Pure methotrexate encephalopathy presenting with seizures: CT and MRI features.
MedLine Citation:
PMID:  9472050     Owner:  NLM     Status:  MEDLINE    
With the advent of chemotherapy, mortality rates in acute lymphoblastic leukaemia (ALL) have decreased, but complications in the central nervous system have appeared. These include direct involvement of the brain itself and the development of chemotherapy-related encephalopathy as a delayed reaction. In most reported cases, this encephalopathy is believed to be due to necrotising angiitis arising from the combination of chemotherapy with adjuvant radiotherapy. We report the cases of four children with ALL who had been treated with high-dose intravenous and intrathecal chemotherapy but no radiation therapy, and who were admitted to hospital because of seizures. CT of the brain revealed the presence of diffuse periventricular white matter hypodensities in all cases and subcortical hyperdense foci in three cases. MRI showed diffuse hyperintense white matter lesions on T2-weighted images in all four patients; hypointense changes were observed on susceptibility-sensitive FLASH sequences in the hyperdense foci seen on CT as well as changes that were hyperintense on T1-weighted images. It was, therefore, concluded that the lesions corresponded to a leukoencephalopathy with calcific deposits. These findings are of a pure form of methotrexate encephalopathy causing seizures.
K Lövblad; P Kelkar; C Ozdoba; G Ramelli; L Remonda; G Schroth
Publication Detail:
Type:  Case Reports; Journal Article    
Journal Detail:
Title:  Pediatric radiology     Volume:  28     ISSN:  0301-0449     ISO Abbreviation:  Pediatr Radiol     Publication Date:  1998 Feb 
Date Detail:
Created Date:  1998-04-09     Completed Date:  1998-04-09     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  0365332     Medline TA:  Pediatr Radiol     Country:  GERMANY    
Other Details:
Languages:  eng     Pagination:  86-91     Citation Subset:  IM    
Department of Neuroradiology, Institute of Diagnostic Radiology, Inselspital, University of Bern, CH-3010 Bern, Switzerland.
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MeSH Terms
Antineoplastic Agents / adverse effects*
Brain / pathology*,  radiography
Brain Diseases / chemically induced*,  pathology*,  radiography
Calcinosis / chemically induced
Child, Preschool
Magnetic Resonance Imaging
Methotrexate / adverse effects*
Precursor Cell Lymphoblastic Leukemia-Lymphoma / drug therapy*
Seizures / chemically induced*
Tomography, X-Ray Computed
Reg. No./Substance:
0/Antineoplastic Agents; 59-05-2/Methotrexate

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