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Methotrexate Encephalopathy as a Cause of Alternating Hemiplegia (P3.143)
CONCLUSIONS: Transient neurologic dysfunction with reversible MRI abnormality is a recognized consequence of intrathecal methotrexate chemotherapy in childhood ALL. Patients present with dramatic fluctuating neurologic symptoms with associated MRI changes and may be mistaken for stroke or a seizure disorder. Once the syndrome is recognized patients typically recover with supportive management and rehabilitation.Disclosure: Dr. Sullivan has nothing to disclose. Dr. Quealy has nothing to disclose. Dr. Olsevskaite has nothing to disclose. Dr. MacEneaney has nothing to disclose. Dr. Ryan has nothing to disclose. Dr. O'Toole ha...
Source: Neurology - April 8, 2015 Category: Neurology Authors: Sullivan, C., Quealy, J., Olsevskaite, J., MacEneaney, P., Ryan, C., O'Toole, O. Tags: Neuro-oncology: CNS Lymphoma and Other Hematologic Malignancies Source Type: research

Teaching NeuroImages: Methotrexate neurotoxicity: Resolution and evolution of MRI changes within 48 hours
A 13-year-old girl presented with acute-onset right hemiparesis involving the face, arm, and leg equally. She was receiving weekly intrathecal methotrexate (last dose 6 days prior) for recently diagnosed acute lymphocytic leukemia. Brain MRI (figure 1) showed diffusion restriction in the left centrum semiovale with reduced apparent diffusion coefficient. Her hemiparesis resolved within 24 hours but 2 hours later, she developed 12-hour left hemiparesis involving face, upper limb, and dysarthria. Follow-up neurologic examination was normal. Repeat MRI (figure 2) 44 hours after the original MRI showed acute right centrum semi...
Source: Neurology - September 2, 2013 Category: Neurology Authors: Kanaan, S., Poddar, K., Ng, Y.-T. Tags: Childhood stroke, MRI, DWI, Chemotherapy-tumor, All Pediatric RESIDENT AND FELLOW SECTION Source Type: research