Neurotoxicity of intrathecal methotrexate: MR imaging findings

AJNR Am J Neuroradiol. 2003 Oct;24(9):1887-90.


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.

Publication types

  • Case Reports

MeSH terms

  • Acute Disease
  • Adolescent
  • Antimetabolites, Antineoplastic / administration & dosage
  • Antimetabolites, Antineoplastic / adverse effects*
  • Brain / pathology
  • Brain Edema / chemically induced
  • Diffusion Magnetic Resonance Imaging
  • Female
  • Humans
  • Injections, Spinal
  • Methotrexate / administration & dosage
  • Methotrexate / adverse effects*
  • Neurotoxicity Syndromes / etiology*
  • Neurotoxicity Syndromes / pathology
  • Precursor Cell Lymphoblastic Leukemia-Lymphoma / drug therapy


  • Antimetabolites, Antineoplastic
  • Methotrexate