Conventional and diffusion-weighted MRI findings of methotrexate related sub-acute neurotoxicity

Balin, Jefferson; Parmar, Hemant; Kujawski, Lisa

doi:10.1016/j.jns.2007.12.012

Cited by 10 publications

(7 citation statements)

References 5 publications

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“…In the NOPHO ALL2008 protocol, methotrexate, prednisolone, vincristine, doxorubicin, and asparaginase were given during induction. Methotrexate is known to cause neurotoxicity, commonly leukoencephalopathy and stroke‐like syndrome (SLS), but has also been associated with PRES . Vincristine has mostly been linked to peripheral neuropathy, but emerging data also indicate a possible causal relationship to PRES .…”

Section: Discussionmentioning

confidence: 99%

“…Methotrexate is known to cause neurotoxicity, commonly leukoencephalopathy and stroke-like syndrome (SLS), but has also been associated with PRES. [27][28][29] Vincristine has mostly been linked to peripheral neuropathy, but emerging data also indicate a possible causal relationship to PRES. 9,28,30,31 Prednisolone increases the risk for PRES, probably indirectly due to an increase in blood pressure.…”

Section: Discussionmentioning

confidence: 99%

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Posterior reversible encephalopathy syndrome in children with acute lymphoblastic leukemia: Clinical characteristics, risk factors, course, and outcome of disease

Anastasopoulou

Eriksson

Heyman

et al. 2018

Pediatric Blood & Cancer

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Background Posterior reversible encephalopathy syndrome (PRES) is a distinct entity with incompletely known predisposing factors. The aim of this study is to describe the incidence, risk factors, clinical course, and outcome of PRES in childhood acute lymphoblastic leukemia (ALL). Procedure Patients aged 1.0 to 17.9 years diagnosed with ALL from July 2008 to December 2015 and treated according to the Nordic Society of Pediatric Hematology and Oncology (NOPHO) ALL2008 protocol were included. Patients with PRES were identified in the prospective NOPHO leukemia toxicity registry, and clinical data were collected from the medical records. Results The study group included 1378 patients, of whom 52 met the criteria for PRES. The cumulative incidence of PRES at one month was 1.7% (95% CI, 1.1–2.5) and at one year 3.7% (95% CI, 2.9–4.9). Older age (hazard ratios [HR] for each one‐year increase in age 1.1; 95% CI, 1.0–1.2, P = 0.001) and T‐cell immunophenotype (HR, 2.9; 95% CI, 1.6–5.3, P = 0.0005) were associated with PRES. Central nervous system (CNS) involvement (odds ratios [OR] = 2.8; 95% CI, 1.2–6.5, P = 0.015) was associated with early PRES and high‐risk block treatment (HR = 2.63; 95% CI, 1.1–6.4, P = 0.033) with late PRES. At follow‐up of the PRES patients, seven patients had epilepsy and seven had neurocognitive difficulties. Conclusion PRES is a neurotoxicity in the treatment of childhood ALL with both acute and long‐term morbidity. Older age, T‐cell leukemia, CNS involvement and high‐risk block treatment are risk factors for PRES.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Posterior reversible encephalopathy syndrome in children with acute lymphoblastic leukemia: Clinical characteristics, risk factors, course, and outcome of disease

Anastasopoulou

Eriksson

Heyman

et al. 2018

Pediatric Blood & Cancer

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“…Recently, DWI has been recognized as being important in the detection of metabolic encephalopathy. A high signal in DWI with low ADC, suggesting the presence of cytotoxic edema, has been described in various metabolic encephalopathies, including Wernicke's encephalopathy, 14 methotrexate-induced encephalopathy 15,16 and metronidazole-induced encephalopathy. 17 DWI may have a significant role in the detection of 5-FU-induced encephalopathy during an acute period because DWI shows symmetric restricted diffusion, which can be normalized with the improvement of clinical symptoms.…”

Section: Discussionmentioning

confidence: 98%

Reversible encephalopathy following 5‐fluorouracil‐based chemotherapy in patients with dihydropyrimidine dehyrogenase deficiency

Kim¹,

Oh²,

Cho

et al. 2009

Asia-Pac J Clncl Oncology

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5-fluorouracil (5-FU) is one of the most frequently used chemotherapy agents for the treatment of a number of solid cancers. We report two patients with advanced gastric cancer who developed acute encephalopathy after receiving chemotherapy composed of 5-FU and oxaliplatin. One patient presented with altered consciousness and the other with generalized tonic clonic seizure. 5-FU-induced encephalopathy was suspected by clinical, radiological and electroencephalographic findings, and both patients had reduced expression of dihyropyrimidine dehydrogenase, the rate-limiting enzyme responsible for the catabolism of 5-FU. The neurological symptoms improved spontaneously, and did not recur in the following cycle of chemotherapy with the administration of a reduced dose of 5-FU. We suggest that the early recognition of this adverse event can reverse 5-FU-induced neurological symptoms and a dose reduction of the offending drug can prevent the recurrence of 5-FU induced encephalopathy.

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“…T 2 images may be normal initially but subsequently demonstrate hyperintensity [87]. Interestingly, the diffusion restriction is typically transient with diffusion signal abnormalities partially or completely resolving within days of symptom resolution [88][89][90][91]. This has led several authors to speculate that the underlying cause of diffusion restriction in methotrexate-induced leukoencephalopathy is reversible cytotoxic oedema within myelin sheaths but with no underlying structural damage [88][89][90][91], a process that is probably mediated by glutamate [23,92].…”

Section: Methotrexate Toxicitymentioning

confidence: 99%

“Dazed and diffused”: making sense of diffusion abnormalities in neurologic pathologies

O’Connor

Barest²,

Moritani³

et al. 2013

BJR

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To review diffusion abnormalities seen in diffusion-weighted MRI in neurological pathologies. We examine the clinical significance of the abnormalities in a broad spectrum of neurological diseases and highlight our current understanding of their causes. Diffusion abnormalities seen on diffusion-weighted MRI can play an important role in the diagnosis and follow-up of a broad spectrum of neurological diseases. A thorough understanding of the appearance and significance of these abnormalities is critical in patient management.Although the best known use of diffusion-weighted imaging (DWI) in MRI of the brain is detection of acute vaso-occlusive infarct, diffusion abnormalities occur in a wide spectrum of neurological pathologies. These diffusion abnormalities provide information that can directly affect the management of a patient, whether identifying pathology that would otherwise go unrecognised, narrowing a broad differential diagnosis, identifying conditions that require emergent intervention, evaluating response to treatment or providing prognostic information about a patient's expected clinical course. In this review, we explain the significance of diffusion abnormalities in a variety of neurological diseases and highlight our current understanding of the causes of these diffusion abnormalities.

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Conventional and diffusion-weighted MRI findings of methotrexate related sub-acute neurotoxicity

Cited by 10 publications

References 5 publications

Posterior reversible encephalopathy syndrome in children with acute lymphoblastic leukemia: Clinical characteristics, risk factors, course, and outcome of disease

Posterior reversible encephalopathy syndrome in children with acute lymphoblastic leukemia: Clinical characteristics, risk factors, course, and outcome of disease

Reversible encephalopathy following 5‐fluorouracil‐based chemotherapy in patients with dihydropyrimidine dehyrogenase deficiency

“Dazed and diffused”: making sense of diffusion abnormalities in neurologic pathologies

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