Pediatric Radiology

, 41:1455 | Cite as

Medication neurotoxicity in children

  • Ramesh S. IyerEmail author
  • Apeksha Chaturvedi
  • Sumit Pruthi
  • Paritosh C. Khanna
  • Gisele E. Ishak
Pictorial Essay


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.


Medication neurotoxicity Posterior reversible leukoencephalopathy syndrome Acute toxic leukoencephalopathy Children 


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Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • Ramesh S. Iyer
    • 1
    Email author
  • Apeksha Chaturvedi
    • 1
  • Sumit Pruthi
    • 2
  • Paritosh C. Khanna
    • 1
  • Gisele E. Ishak
    • 1
  1. 1.Department of RadiologySeattle Children’s HospitalSeattleUSA
  2. 2.Department of Radiology and Radiological Sciences and PediatricsMonroe Carell Jr. Children’s Hospital at Vanderbilt UniversityNashvilleUSA

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