0:01

In addition to methotrexate, one of the

0:03

other medications that also is used for

0:07

lymphoma/leukemia patients is fludarabine.

0:10

And this drug, similar to methotrexate, may show white

0:16

matter changes that are positive on diffusion-weighted

0:20

imaging and your ADC map but may be negative on

0:26

FLAIR imaging. So, medication-induced toxic

0:30

leukoencephalopathy, in this case by a different drug,

0:34

fludarabine, which is also a lymphoma/leukemia drug.

0:40

So, we have a nice article that was

0:42

written in the American Journal of

0:45

Neuroradiology, February 2019 edition,

0:49

entitled Acute Toxic Leukoencephalopathy, and

0:52

all these can lead to acute changes in mental

0:56

status that will lead you to have that as

1:00

the indication for the emergency department

1:03

MRI scan, either from the floors or from patients who

1:07

are brought in to the emergency department itself.

1:10

Usually, periventricular white matter.

1:12

They are usually readily reversible, but as in

1:16

methotrexate leukoencephalopathy, it can lead

1:19

to substantial morbidity and even mortality.

1:23

Most commonly, these are due to chemotherapy

1:26

drugs, but it can be due to illicit drugs that are

1:28

being taken on the street and immunosuppressive drugs.

1:34

As I mentioned, and as I showed you with

1:35

methotrexate and fludarabine, they may

1:38

be positive on DWI but FLAIR negative.

1:42

Here is an additional case of methotrexate-induced

1:45

leukoencephalopathy—DWI positive, ADC positive,

1:50

and yet nothing to be seen here on the FLAIR scan.

1:53

That's a very unusual pattern in general,

1:57

but it is a pattern that may be seen

1:59

with methotrexate or fludarabine.s

Toxic Leukoencephalopathy

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