Diffusion Magnetic Resonance Imaging Findings in Acute Methotrexate Neurotoxicity

DSF Tsang, PL Khong

Hong Kong J Radiol 2005;8:250-3

We present the case of a patient with right fibular osteosarcoma, who was treated with multiple chemotherapeutic agents, including methotrexate, according to the Hong Kong Paediatric Haematology and Oncology Study Group osteogenic sarcoma protocol. After eight weeks of treatment, he developed acute neurological symptoms, paralleled by diffusion magnetic resonance imaging brain scan findings of restricted diffusion in the white matter within 24 hours of symptom onset. Subsequently, three more sequential magnetic resonance imaging brain scans were performed, with the last scan, performed at five months after symptom onset, showing regression of the lesion.