Child with acute methotrexate related neurotoxicity: Can diffusion weighted MRI help??

Abstract

Background: Methotrexate is widely used chemotherapy especially in pediatric hematological malignancy. It may associate with acute neurotoxicity. We evaluate the role of the diffusion-weighted imaging (DWI) in the early detection of the acute methotrexate neurotoxicity. Methods: Seventeen pediatric patients receiving high-dose methotrexate with clinical manifestation of neurotoxicity (seizures, headache, aphasia, hemiparesis or altered mental status) were included in our study. MRI was obtained in all cases within 48 h of onset of symptoms. DWI was done as a part of the routine MRI study. Results: In all patients, initial MRI showed abnormal restricted diffusion in the centrum semiovale. FLAIR is positive in 9 cases showing bright signal. All patients had follow-up MR (within two weeks); in all cases there was resolution of the diffusion abnormality and interval development of abnormal signal intensity on FLAIR and T2WI. Conclusion: Methotrexate can result in reversible neurotoxicity in the form of white matter injury. DWI may be used in early detection of such changes; therefore, it provides a rapid, noninvasive readily available tool by which neurotoxicity can be early detected and treated. It has the potential to alert the oncologist to this event and provide a technique by which neurotoxicity can be monitored. Published by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http:// creativecommons.org/licenses/by-nc-nd/4.0/).

Methotrexate-induced Acute Myelopathy in a Teenager With High-risk Acute Lymphoblastic Leukemia

“…In the literature, the occurence of myelitis appears to be independent of delayed intravenous MTX excretion and plasmatic MTX concentration. 1 The use of folinic acid rescue does not seem to alleviate neurological symptomatology.…”

“…It occurs usually in case of concomitant radiation, and settles several months after the beginning of treatment. 1,5 Cases of asymptomatic MTX-induced white matter lesions on MRI have also been observed.…”

“…The reported incidence of MTX-related neurotoxicity for patients with ALL is between 9% and 53%. 1 Acute encephalopathy is a transient complication occurring generally within 5 to 14 days after IT MTX or HD IV MTX: it may include headache, altered mental status, impaired vision, seizure, and sometimes focal deficits. Hypertension is usually present.…”

Neurotoxic Complications of Chemotherapy in Children. Literature Review

“…Также нейротоксичность проявлялась такими симптомами, как головная боль, судороги, речевые нарушения по типу афазии, двигательные расстройства в виде гемипареза, изменения психического статуса. Использование метотрексата приводило к обратимым изменениям белого вещества головного мозга [34,35].…”

Subacute methotrexate-induced encephalopathy: features of diagnostics and treatment options. Clinical case report

“… 2019 by NMRC PHOI М етотрексат (МТХ) -широко используемый противоопухолевый препарат из группы антиметаболитов, антагонистов фолиевой кислоты, доказавших свою эффективность при большом спектре онкогематологических заболеваний у детей [1][2][3][4]. Применение МТХ в высоких дозах имеет ряд преимуществ при лечении опухолей центральной нервной системы (ЦНС), остеосарком, острых лимфобластных лейкозов, лимфом, однако МТХ высокотоксичен и в ряде случаев может стать причиной развития тяжелой нейротоксичности (острой, подострой, хронической) [1,3].…”