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Pediatric Radiology

, Volume 28, Issue 2, pp 86–91 | Cite as

Pure methotrexate encephalopathy presenting with seizures: CT and MRI features

  • K.-O. Lövblad
  • Pramod Kelkar
  • Christoph Ozdoba
  • Gianpaolo Ramelli
  • Luca Remonda
  • Gerhard Schroth

Abstract

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.

Keywords

White Matter Methotrexate Adjuvant Radiotherapy White Matter Lesion Direct Involvement 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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Copyright information

© Springer-Verlag Berlin Heidelberg 1998

Authors and Affiliations

  • K.-O. Lövblad
    • 1
  • Pramod Kelkar
    • 1
  • Christoph Ozdoba
    • 1
  • Gianpaolo Ramelli
    • 2
  • Luca Remonda
    • 1
  • Gerhard Schroth
    • 1
  1. 1.Department of Neuroradiology, Institute of Diagnostic Radiology, Inselspital, University of Bern, CH-3010 Bern, SwitzerlandCH
  2. 2.Department of Pediatrics, Inselspital, University of Bern, Bern, SwitzerlandCH

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