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Assessment of Endothelial Cell Migration After Exposure to Toxic Chemicals

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Published on: July 10, 2015

Methotrexate-induced acute toxic leukoencephalopathy.

Parag R Salkade¹, Teh Aun Lim

¹Department of Diagnostic Radiology, Singapore General Hospital, Singapore. paragrsalkade@gmail.com

Journal of Cancer Research and Therapeutics

|July 31, 2012

Summary

High-dose methotrexate for childhood leukemia can cause temporary neurotoxicity. Diffusion-weighted MRI (DW-MRI) detected reversible white matter changes in a patient experiencing limb weakness and facial nerve paresis after treatment.

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Area of Science:

Neuroscience
Pediatric Oncology
Radiology

Background:

High-dose methotrexate (MTX) is crucial for treating childhood acute lymphoblastic leukemia (ALL), eradicating cancer cells in the central nervous system (CNS).
MTX administration, while effective, carries a risk of neurotoxicity, potentially affecting white matter regions.
Methotrexate-induced acute toxic leukoencephalopathy presents with diverse neurological symptoms.

Observation:

A teenage girl with ALL experienced two episodes of left-sided limb weakness and facial nerve palsy after MTX treatment.
Diffusion-weighted MRI (DW-MRI) revealed focal restricted diffusion in the right centrum semiovale after each neurological episode.
Neurological deficits resolved within three days, with follow-up DW-MRI showing resolution of restricted diffusion.

Findings:

DW-MRI is a sensitive tool for detecting acute MTX-induced neurotoxicity, manifesting as reversible restricted diffusion in white matter.
The observed lesions on DW-MRI correlated with transient neurological deficits.
Complete resolution of imaging findings and absence of long-term neurological or intellectual impairment were noted.

Implications:

This case highlights the utility of DW-MRI in diagnosing and monitoring MTX-induced neurotoxicity in pediatric ALL patients.
Understanding these reversible changes can help differentiate MTX toxicity from other neurological events like stroke.
Prompt recognition and monitoring may prevent misdiagnosis and ensure appropriate patient management.