Presentation
Systemic malignancy
Patient Data
Widespread involvement of the deep white matter (high T2 signal) without contrast enhancement or restricted diffusion. Note how the subcortical U-fibres are spared (best seen on FLAIR).
Diffuse involvement of the white matter around the red-nuclei makes the red nuclei stand out mimicking a panda's face. Superiorly, the subcortical U-fibres are spared (blue arrows).
Case Discussion
This patient received both intrathecal methotrexate and whole body (including cranial) irradiation. They then presented with gradual decrease in cognitive function.
Findings are thought to be consistent with a toxic leukoencephalopathy.
Intravenous methotrexate is associated with TL in 10% whereas it is seen in up to 40% of those who are treated by the intrathecal route.
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