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Transient encephalopathy after intrathekal methotrexate chemotherapy: diffusion-weighted MRI

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Summary

Methotrexate (MTX) is an indispensable antimetabolite for the treatment of oncological and immunological disorders in all age groups. Chronic leukoencephalopathy is a well know side effect of MTX, especially in conjunction with intrathecal administration and whole brain radio therapy. However, acute neurotoxicity with confusion, disorientation, seizures and focal deficits has also been reported. Because acute neurological symptoms in patients under chemotherapy for neoplastic disorders may have many reasons, MR-imaging is usually necessary to identify the underlying pathology. Apart from conventional sequences, diffusion-weighted imaging (DW-MRI) is frequently performed. We report on clinical and imaging findings of reversibly restricted diffusion in a patient with transient encephalopathy after intrathecal administration of MTX for recurrent acute lymphatic leukaemia.

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References

  1. F Ebner G Ranner I Slavc C Urban R Kleinert H. Radner et al. (1989) ArticleTitleMR findings in methotrexate-induced CNS abnormalities AJNR Am J Neuroradiol 10 IssueID5 959–964 Occurrence Handle1:STN:280:BiaA2s7jsFU%3D Occurrence Handle2505541

    CAS  PubMed  Google Scholar 

  2. K Matsumoto S Takahashi A Sato M Imaizumi S Higano K Sakamoto et al. (1995) ArticleTitleLeukoencephalopathy in childhood hematopoietic neoplasm caused by moderate-dose methotrexate and prophylactic cranial radiotherapy – an MR analysis Int J Radiat Oncol Biol Phys 32 IssueID4 913–918 Occurrence Handle10.1016/0360-3016(95)00565-G Occurrence Handle1:STN:280:ByqA3s3gvFI%3D Occurrence Handle7607965

    Article  CAS  PubMed  Google Scholar 

  3. AC Lee CH Li YC. Wong (2003) ArticleTitleTransient encephalopathy following high-dose methotrexate Med Pediatr Oncol 41 IssueID1 101 Occurrence Handle10.1002/mpo.1339 Occurrence Handle12764767

    Article  PubMed  Google Scholar 

  4. JE Rubnitz MV Relling PL Harrison JT Sandlund RC Ribeiro GK. Rivera et al. (1998) ArticleTitleTransient encephalopathy following high-dose methotrexate treatment in childhood acute lymphoblastic leukemia Leukemia 12 IssueID8 1176–1181 Occurrence Handle10.1038/sj.leu.2401098 Occurrence Handle1:CAS:528:DyaK1cXlsF2qur8%3D Occurrence Handle9697870

    Article  CAS  PubMed  Google Scholar 

  5. H Peyriere M Poiree M Cociglio G Margueritte S Hansel D. Hillaire-Buys (2001) ArticleTitleReversal of neurologic disturbances related to high-dose methotrexate by aminophylline Med Pediatr Oncol 36 IssueID6 662–664 Occurrence Handle10.1002/mpo.1149 Occurrence Handle1:STN:280:DC%2BD3M3kt1alsA%3D%3D Occurrence Handle11344503

    Article  CAS  PubMed  Google Scholar 

  6. PW Schaefer FS Buonanno RG Gonzales LH. Schwamm (1997) ArticleTitleDiffusion-weighted imaging discriminates between cytotoxic and vasogenic edema in a patient with eclampsia Stroke 28 1082–1085 Occurrence Handle1:STN:280:ByiA3c3ivFY%3D Occurrence Handle9158653

    CAS  PubMed  Google Scholar 

  7. S Warach J Gaa B Siewert P Wielopolski RR. Edelman (1995) ArticleTitleAcute human stroke studied by whole brain echo planar diffusion-weighted magnetic resonance imaging Ann Neurol 37 231–241 Occurrence Handle10.1002/ana.410370214 Occurrence Handle1:STN:280:ByqC2M%2FlsVc%3D Occurrence Handle7847864

    Article  CAS  PubMed  Google Scholar 

  8. I Mader U Herrlinger U Klose F Schmidt W. Kuker (2003) ArticleTitleProgressive multifocal leukoencephalopathy: analysis of lesion development with diffusion-weighted MRI Neuroradiology 45 IssueID10 717–721 Occurrence Handle10.1007/s00234-003-0966-4 Occurrence Handle1:STN:280:DC%2BD3svos1Sqsw%3D%3D Occurrence Handle12942223

    Article  CAS  PubMed  Google Scholar 

  9. AY Liu JA Maldjian LJ Bagley GP Sinson RI. Grossman (1999) ArticleTitleTraumatic brain injury: diffusion-weighted MR imaging findings AJNR Am J Neuroradiol 20 IssueID9 1636–141 Occurrence Handle1:STN:280:DC%2BD3c%2FgvV2kug%3D%3D Occurrence Handle10543633

    CAS  PubMed  Google Scholar 

  10. L Nadal Desbarats S Herlidou G Marco Particlede C Gondry-Jouet D Le Gars H. Deramond et al. (2003) ArticleTitleDifferential MRI diagnosis between brain abscesses and necrotic or cystic brain tumors using the apparent diffusion coefficient and normalized diffusion-weighted images Magn Reson Imaging 21 IssueID6 645–650 Occurrence Handle10.1016/S0730-725X(03)00084-5 Occurrence Handle12915196

    Article  PubMed  Google Scholar 

  11. M Oka S Terae R Kobayashi Y Sawamura K Kudoh KK. Tha (2003) ArticleTitleMRI in methotrexate-related leukoencephalopathy: disseminated necrotising leukoencephalopathy in comparison with mild leukoencephalopathy. Neuroradiology 45 IssueID1 493–497 Occurrence Handle10.1007/s00234-003-0983-3 Occurrence Handle1:STN:280:DC%2BD3szltFCgsQ%3D%3D Occurrence Handle12761601

    Article  CAS  PubMed  Google Scholar 

  12. C Sandoval M Kutscher S Jayabose M. Tenner (2003) ArticleTitleNeurotoxicity of intrathecal methotrexate: MR imaging findings AJNR Am J Neuroradiol 24 IssueID9 1887–1890 Occurrence Handle14561622

    PubMed  Google Scholar 

  13. ST Lee M. Kim (2004) ArticleTitleDiffusion-weighted MRIs in an acute leukoencephalopathy following intrathecal chemotherapy Neurology 62 IssueID5 832–833 Occurrence Handle15007149

    PubMed  Google Scholar 

  14. DA Wilson R Nitschke ME Bowman MJ Chaffin CL Sexauer JR. Prince (1991) ArticleTitleTransient white matter changes on MR images in children undergoing chemotherapy for acute lymphocytic leukemia: correlation with neuropsychologic deficiencies Radiology 180 IssueID1 205–209 Occurrence Handle1:STN:280:By6B2s7lsV0%3D Occurrence Handle2052695

    CAS  PubMed  Google Scholar 

  15. R Asato Y Akiyama M Ito M Kubota R Okumura Y. Miki et al. (1992) ArticleTitleNuclear magnetic resonance abnormalities of the cerebral white matter in children with acute lymphoblastic leukemia and malignant lymphoma during and after central nervous system prophylactic treatment with intrathecal methotrexate Cancer 70 IssueID7 1997–2004 Occurrence Handle1:STN:280:By2H3crgvFc%3D Occurrence Handle1525778

    CAS  PubMed  Google Scholar 

  16. JC Bernini DW Fort JC Griener BJ Kane WB Chappell BA. Kamen (1995) ArticleTitleAminophylline for methotrexate-induced neurotoxicity Lancet 345 IssueID8949 544–547 Occurrence Handle10.1016/S0140-6736(95)90464-6 Occurrence Handle1:STN:280:ByqB1Mrkt1I%3D Occurrence Handle7776773

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Neuroradiology, University Hospital Tübingen, Hoppe-Seyler-Street. 3, Tübingen, Germany, D-72076

    W. Küker, S. Heckl & T. Nägele

  2. Department of Neuroradiology, The Radcliffe Infirmary, Woodstock Road, Oxford, UK

    W. Küker

  3. Department of Pediatric Oncology, UK

    P. Bader

  4. Department of Neurology, University of Tübingen Medical School, Tübingen, Germany

    U. Herrlinger

Authors
  1. W. Küker
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  2. P. Bader
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  3. U. Herrlinger
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  4. S. Heckl
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  5. T. Nägele
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Correspondence to W. Küker.

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Küker, W., Bader, P., Herrlinger, U. et al. Transient encephalopathy after intrathekal methotrexate chemotherapy: diffusion-weighted MRI. J Neurooncol 73, 47–49 (2005). https://doi.org/10.1007/s11060-004-2929-y

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  • DOI: https://doi.org/10.1007/s11060-004-2929-y

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