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Case: Toxic Leukoencephalopathy from Medication on MRI

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I did want to make the point before moving

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on that leukoencephalopathy from medications

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need not be seen as a pattern where the

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DWI is positive and the FLAIR is negative.

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Here is another patient with

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methotrexate leukoencephalopathy.

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In this case,

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the FLAIR scan on the left side is grossly abnormal.

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It's symmetric.

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And that should give you the clue that this is

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likely either metabolic or medication induced.

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However, on this case, the

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DWI scan is completely normal.

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No cytotoxic edema, so methotrexate

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leukoencephalopathy has different patterns.

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It may be diffusion negative, FLAIR positive,

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it may be diffusion positive, FLAIR positive.

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And it may be diffusion positive and FLAIR negative.

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So there are many different manifestations of the

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same entity of methotrexate leukoencephalopathy

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typically seen in patients who are receiving

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the drugs for lymphoma and/or leukemia.

Report

Faculty

David M Yousem, MD, MBA

Professor of Radiology, Vice Chairman and Associate Dean

Johns Hopkins University

Tags

Neuroradiology

MRI

Emergency

Drug related

Brain

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