Presentation
Headache, nausea and dizziness.
Patient Data
The patient is a known case of T-cell acute lymphocytic leukemia, undergoing chemotherapy with German Multicenter Study Group for Adult Acute Lymphoblastic Leukemia (GMALL) protocol.
MRI shows diffuse bilaterally symmetrical, confluent, T1 hypointense, T2 and FLAIR hyperintense signals in the subcortical and deep white matter, involving bilateral centrum semi-ovale, bilateral corona radiata, and peri-ventricular regions. No restriction on DW and ADC images was seen. No blooming on SWI seen. No post contrast enhancement seen.
Case Discussion
The patient is a known case of T-cell acute lymphocytic leukemia. Chemotherapy using ‘German Multicenter Study Group for Adult Acute Lymphoblastic Leukemia (GMALL) protocol’ is used for its treatment 1 (as was used in this case).
The patient had received intrathecal methotrexate in the induction phase and is presently on weekly oral methotrexate in the maintenance phase.
Toxic leukoencephalopathy occurs due to damage to the cerebral white matter myelin. It is most commonly caused by chemotherapeutic agents, methotrexate and 5-Fluoro-uracil 2.
In this condition, MRI shows confluent, symmetrical, altered signal intensity areas (isointense to hypointense on T1W images, hyperintense on FLAIR and T2W images) in bilateral centrum semi-ovale and bilateral corona radiata, peri-ventricular deep white matter near frontal and occipital horns of lateral ventricles 2 (as observed in this case).