Question 2593
{"accessible":true,"alternatives":[{"id":12726,"text":"brain abscess"},{"id":12725,"text":"chloroma"},{"id":12727,"text":"methotrexate toxicity"},{"id":12729,"text":"metronidazole toxicity"},{"id":12728,"text":"vigabatrin toxicity"}],"archived":false,"correctAlternativeId":12727,"explanation":"\u003cp\u003eThe apparent diffusion coefficient map shows an ovoid region of restricted diffusion in the left centrum semiovale. The history of ALL indicates a possibility of receiving intrathecal chemotherapy, usually methotrexate. The centrum semiovale location and ovoid shape are typical of methotrexate neurotoxicity. Lesions can be unilateral or bilateral.\u003c/p\u003e\u003cp\u003eThe lesion is associated with no surrounding edema, making brain abscess unlikely.\u003c/p\u003e\u003cp\u003eChloroma is an outdated term for what is now known as myeloid sarcoma, which refers to focal deposits of an acute myeloid leukemia, not lymphoblastic leukemia.\u003c/p\u003e\u003cp\u003eMetronidazole is used to treat infections and associated toxicity causes signal changes in the dentate nuclei and possibly brainstem or corpus callosum.\u003c/p\u003e\u003cp\u003eVigabatrin is used to treat infantile spasms and associated toxicity causes signal changes in the globi pallidi, thalami, dorsal brainstem (central tegmental tracts), and dentate nuclei.\u003c/p\u003e","id":2593,"imageUrl":"https://prod-images-static.radiopaedia.org/images/28690922/d7fe969d19f5cd637aa403ecbf231e_big_gallery.jpeg","imageAttribution":{"kind":"case","rID":51348},"imageAttributionCaseInfo":{"title":"Methotrexate toxicity","contributor_name":"Y. Amy Chen","contributor_param":"y-amy-chen","case_rid":51348,"case_param":"methotrexate-toxicity-1"},"firstQuestionPath":"/questions/2593","nextQuestionPath":"/articles/cerebral-abscess-1/questions/2132","relatedArticles":[{"id":39532,"title":"Metronidazole central nervous system toxicity","link":"/articles/metronidazole-central-nervous-system-toxicity-1?lang=us"},{"id":52847,"title":"Methotrexate-related leukoencephalopathy","link":"/articles/methotrexate-related-leukoencephalopathy?lang=us"},{"id":10568,"title":"Myeloid sarcoma","link":"/articles/myeloid-sarcoma-1?lang=us"}],"alsoUsedIn":[{"id":1397,"kind":"Course","title":"Toxic \u0026 Metabolic Brain Disorders in Adults - page 1397","link":"https://radiopaedia.org/courses/toxic-and-metabolic-brain-disorders/pages/1397"},{"id":2238,"kind":"Course","title":"Toxic \u0026 Metabolic Brain Disorders in Adults Peer Review - page 2238","link":"https://radiopaedia.org/courses/toxic-and-metabolic-brain-disorders-peer-review/pages/2238"}],"stem":"\u003cp\u003eA 14-year-old with acute lymphoblastic leukemia presents with acute right hemiplegia and is evaluated with brain MRI. What is the most likely diagnosis?\u003c/p\u003e","menuLinks":[{"text":"Report problem with question","url":"https://docs.google.com/forms/d/e/1FAIpQLSfO3soWYhOjJ7yErSysyCe5V4A1CqW7WK3rDA7MtAkecMGqNw/viewform?entry.1624461248\u0026entry.553583435=https://radiopaedia.org/questions/2593"}],"attemptsPercentages":[{"alternativeId":"12725","percentage":5},{"alternativeId":"12728","percentage":7},{"alternativeId":"12727","percentage":77},{"alternativeId":"12726","percentage":8},{"alternativeId":"12729","percentage":4}],"promptToLogin":false,"questionManager":false,"articleId":"cerebral-abscess"}