History of ALL on intrathecal methotrexate. Presents with acute onset of right hemiplegia, hemisensory loss, and dysarthria 10 days after most recent cycle of chemotherapy.
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Oval region of restricted diffusion in the left posterior centrum ovale.
Methotrexate is a cause of acute neurotoxicity in children with hematologic malignancies. Patients most commonly present with acute onset of hemiplegia or aphasia, often 6-11 days after intrathecal methotrexate administration. Classic imaging finding is restricted diffusion in bilateral or unilateral centrum semiovale. Follow-up imaging in 1-2 months usually shows resolution of diffusion abnormality and development of abnormal signal intensity on FLAIR and T2WI.
- Fisher MJ et al. Diffusion-Weighted MR Imaging of Early Methotrexate-Related Neurotoxicity in Children. AJNR 2005. 26:1686–1689.