Methotrexate toxicity

Case contributed by Dr Y. Amy Chen


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.

Patient Data

Age: 14 years
Gender: Male

Oval region of restricted diffusion in the left posterior centrum ovale. 

Case Discussion

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. 

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Case information

rID: 51348
Published: 12th Feb 2017
Last edited: 25th Aug 2020
Inclusion in quiz mode: Included

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