Assessment of brain perfusion by 99mTc-HMPAO SPECT in akinetic mutism due to high-dose intravenous methotrexate therapy

Childs Nerv Syst. 1997 Oct;13(10):560-2. doi: 10.1007/s003810050138.


Chemotherapy of the central nervous system may cause neurotoxicity in children with acute lymphocytic leukemia. We evaluated regional blood flow in a 6-year-old child presenting with akinetic mutism, using 99mTc-HMPAO single photon emission tomography (SPECT) following high-dose intravenous methotrexate therapy. While findings in X-ray computerized tomography were decreased density in bilateral basal ganglia and thalamic nuclei with diffusely decreased attenuation of the periventricular white matter, a global, frontal dominant profoundly abnormal perfusion pattern involving both gray and white matter was observed in the SPECT study. Treatment of the central nervous system with high dose intravenous chemotherapy may cause profound abnormalities in white and gray matter blood flow and early assessment of the neurotoxicity may be identified by 99mTc-HMPAO SPECT in the pediatric age group.

Publication types

  • Case Reports

MeSH terms

  • Akinetic Mutism / chemically induced*
  • Akinetic Mutism / diagnostic imaging
  • Antimetabolites, Antineoplastic / administration & dosage
  • Antimetabolites, Antineoplastic / adverse effects*
  • Antineoplastic Combined Chemotherapy Protocols / administration & dosage
  • Antineoplastic Combined Chemotherapy Protocols / adverse effects
  • Brain / blood supply*
  • Child
  • Dominance, Cerebral / drug effects
  • Dose-Response Relationship, Drug
  • Female
  • Frontal Lobe / blood supply
  • Humans
  • Infusions, Intravenous
  • Methotrexate / administration & dosage
  • Methotrexate / adverse effects*
  • Precursor Cell Lymphoblastic Leukemia-Lymphoma / drug therapy*
  • Regional Blood Flow / drug effects
  • Technetium Tc 99m Exametazime
  • Tomography, Emission-Computed, Single-Photon*


  • Antimetabolites, Antineoplastic
  • Technetium Tc 99m Exametazime
  • Methotrexate