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American Journal of Neuroradiology 24:1887-1890, October 2003
© 2003 American Society of Neuroradiology

Case Report
BRAIN

Neurotoxicity of Intrathecal Methotrexate: MR Imaging Findings

Claudio Sandoval^a, Martin Kutscher^a, Somasundaram Jayabose^a and Michael Tenner^b

^a Department of Pediatrics, New York Medical College, Valhalla, New York
^b Department of Radiology, New York Medical College, Valhalla, New York

Address correspondence to Dr. Claudio Sandoval, New York Medical College, Department of Pediatrics, Munger Pavilion Room 110, Valhalla, New York 10595

Summary: We report a case of intrathecal methotrexate neurotoxicity manifesting as left arm weakness and aphasia. Diagnostic imaging showed restricted diffusion and fluid-attenuated inversion recovery imaging findings were normal at presentation. Three weeks later, diffusion abnormalities resolved, and T2-weighted studies showed increased signal intensity of prolonged T2 changes in areas of prior restricted diffusion. We attribute the clinical and radiographic findings to cytotoxic edema secondary to intrathecal methotrexate.

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