Disseminated necrotizing leukoencephalopathy

Abstract

An 11-year-old boy had a relapse of acute lymphoblastic leukemia involving the CNS. He was treated with whole brain radiotherapy and intrathecal methotrexate. One week after the whole brain radiotherapy, he developed personality changes and right facial weakness. Brain MRI was obtained (Figure 1). Disseminated necrotizing leukoencephalopathy is an uncommon neurotoxicity syndrome associated with whole brain radiotherapy and methotrexate. Personality change is commonly reported 1. Disseminated necrotizing leukoencephalopathy is characterized by subcortical T2-hyperintensities with low-signal foci and corresponding contrast-enhancing areas 1,2. Early cessation of inciting therapies may prevent progression (Figure 2). Our patient returned to his neurologic baseline and at 14-month follow-up remained without further deterioration.