Reversible acute methotrexate leukoencephalopathy: atypical brain MR imaging features

Dan, Bernard; Azzi, Nadira; Ferster, Alina; Damry, Nasroolla; Christophe, Catherine

doi:10.1007/s00247-005-0015-z

Cited by 43 publications

(46 citation statements)

References 22 publications

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“…15 This type of encephalopathy is characterized by the presence of a T2 high-intensity area in the cortex and subcortical white matter, seizures lasting several days, and normalization of the MRI within 3 months. With regard to differential diagnosis, patient 1' s MRI abnormalities were also suspected to be the result of direct invasion of leukemic cells, despite the lack of leukemic cells in the cerebrospinal fluid, due to the presence of gadolinium-enhanced nodules.…”

Section: Discussionmentioning

confidence: 99%

Temporal Lobe Epilepsy With Hippocampal Sclerosis in Acute Lymphoblastic Leukemia

Kasai-Yoshida

Ogihara²,

Ozawa³

et al. 2013

Pediatrics

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Of 71 acute lymphoblastic leukemia survivors at our hospital over the past 10 years, 2 children developed mesial temporal lobe epilepsy with hippocampal sclerosis (MTLE-HS). This is the first report to describe the clinical course of MTLE-HS observed longitudinally by EEG and MRI. Patient 1 experienced a seizure during chemotherapy involving intrathecal methotrexate. Postseizure MRI suggested methotrexate encephalopathy or leukemic invasion. Anticonvulsant therapy was initiated; subsequent EEGs and MRIs revealed normal results. Three years after chemotherapy, a diffuse, irregular spike-and-wave pattern was observed on interictal EEG. Five years after chemotherapy, the patient developed MTLE-HS comprising complex partial seizures, typical temporal spikes on EEG, and hippocampal sclerosis (HS). Patient 2 did not experience seizures during chemotherapy. Four years later, the patient started experiencing complex partial seizures, and a diffuse, irregular spike-and-wave pattern was observed on interictal EEG. A clinical picture of MTLE-HS developed 2 years later. In both patients, nonspecific EEG abnormalities (ie, diffuse, irregular spike-and-wave activity) preceded the appearance of HS on MRI by 2 years, suggesting an insidious advance of HS during the latent period. Such atypical EEG findings may indicate MTLE-HS during follow-up of leukemia patients. MTLE-HS develops several years after an initial precipitating incident such as prolonged seizures, central nervous system infection, and brain trauma. In our cases, the initial precipitating incident may have been chemotherapy and/or prolonged seizures. Thus, MTLE-HS associated with leukemia may not be as rare as generally believed. A large cohort study of late neurologic complications is warranted. Pediatrics 2013;132:e252-e256

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Section: Discussionmentioning

confidence: 99%

Temporal Lobe Epilepsy With Hippocampal Sclerosis in Acute Lymphoblastic Leukemia

Kasai-Yoshida

Ogihara²,

Ozawa³

et al. 2013

Pediatrics

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“…Ziereisen et al [72] showed that at the end of therapy in 90 patients treated with MTX for ALL or non-B malignant non-Hodgkin lymphoma, 15 (17%) had T2 hyperintensities of whom 6 were symptomatic for acute LE, and 9 were asymptomatic. Interestingly, the spatial distribution of the hyperintensities differed in the two groups: asymptomatic subjects had localized, deep periventricular WM changes, and symptomatic subjects had hyperintensities in the supratentorial cortex, cerebellar cortex, cortical and subcortical WM, and thalamus.…”

Section: Magnetic Resonance Diffusion Imaging Studiesmentioning

confidence: 99%

Quantitative morphologic evaluation of magnetic resonance imaging during and after treatment of childhood leukemia

et al. 2007

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Introduction-Medical advances over the last several decades, including CNS prophylaxis, have greatly increased survival in children with leukemia. As survival rates have increased, clinicians and scientists have been afforded the opportunity to further develop treatments to improve the quality of life of survivors by minimizing the long-term adverse effects. When evaluating the effect of antileukemia therapy on the developing brain, magnetic resonance (MR) imaging has been the preferred modality because it quantifies morphologic changes objectively and noninvasively.

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“…This complication presents several months to years after therapy and may lead to severe neuropsychological impairment (Ziereisen et al, 2006).…”

Section: Chronic Leukoencephalopatymentioning

confidence: 99%

Chemotherapy Toxicity in Patients with Acute Leukemia

Vagace¹,

Gervasini²

2011

Acute Leukemia - The Scientist's Perspective and Challenge

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Reversible acute methotrexate leukoencephalopathy: atypical brain MR imaging features

Cited by 43 publications

References 22 publications

Temporal Lobe Epilepsy With Hippocampal Sclerosis in Acute Lymphoblastic Leukemia

Temporal Lobe Epilepsy With Hippocampal Sclerosis in Acute Lymphoblastic Leukemia

Quantitative morphologic evaluation of magnetic resonance imaging during and after treatment of childhood leukemia

Chemotherapy Toxicity in Patients with Acute Leukemia

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