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Pure methotrexate encephalopathy presenting with seizures: CT and MRI features
K Lövblad1, P Kelkar, C Ozdoba
1Department of Neuroradiology, Institute of Diagnostic Radiology, Inselspital, University of Bern, CH-3010 Bern, Switzerland.
Pediatric Radiology
|April 16, 1998
Summary
High-dose chemotherapy for acute lymphoblastic leukemia (ALL) can cause seizures due to methotrexate encephalopathy. This study identifies leukoencephalopathy with calcific deposits as the cause in children without radiation therapy.
Area of Science:
- Neuroscience
- Pediatric Oncology
- Radiology
Background:
- Chemotherapy has reduced acute lymphoblastic leukemia (ALL) mortality but introduced central nervous system complications.
- Chemotherapy-related encephalopathy, often linked to chemotherapy and radiotherapy, presents a significant challenge.
- Understanding CNS complications in ALL treatment is crucial for patient outcomes.
Observation:
- Four children with ALL treated with high-dose chemotherapy (without radiotherapy) presented with seizures.
- Brain CT revealed diffuse periventricular white matter hypodensities and subcortical hyperdense foci.
- Brain MRI showed diffuse T2-weighted hyperintense white matter lesions and susceptibility-sensitive FLASH sequence changes.
Findings:
- The observed brain lesions were consistent with leukoencephalopathy featuring calcific deposits.
- These imaging findings indicate a pure form of methotrexate encephalopathy.
- The leukoencephalopathy was directly correlated with the occurrence of seizures in these patients.
Implications:
- This research highlights a specific neurotoxic effect of high-dose chemotherapy in ALL treatment.
- It underscores the importance of neuroimaging in diagnosing and understanding chemotherapy-induced encephalopathy.
- Findings may inform treatment strategies to mitigate CNS complications in pediatric ALL patients.