Doan Ninh, Patel Mohit, Nguyen Ha Son, Doan Hayley, Shabani Saman, Gelsomino Michael, Mountoure Andrew, Janich Karl, Chitambar Christopher R
Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA, India.
New Berlin High School, New Berlin, Wisconsin, USA.
Asian J Neurosurg. 2018 Jul-Sep;13(3):848-850. doi: 10.4103/ajns.AJNS_324_16.
Methotrexate (MTX) is a common antimetabolite agent that is widely used today in treating leukemia, lymphoma, and osteosarcoma. Its use has been associated with leukoencephalopathy causing seizures, paralysis, and even coma. To achieve the best possible outcome, it is important to be able to make a prompt diagnosis. Studies reported restricted diffusion on diffusion-weighted imaging (DWI) which is a reliable early sign of acute MTX-induced leukoencephalopathy. However, we report here the first case of MTX-induced leukoencephalopathy without typical restricted diffusion on DWI and the utility magnetic resonance spectroscopy to support this diagnosis in the difficult case such as the one being presented here.
甲氨蝶呤（MTX）是一种常见的抗代谢药物，如今广泛用于治疗白血病、淋巴瘤和骨肉瘤。其使用与可导致癫痫发作、瘫痪甚至昏迷的白质脑病有关。为了获得最佳治疗效果，能够迅速做出诊断很重要。研究报告称，弥散加权成像（DWI）上出现弥散受限，这是急性甲氨蝶呤诱导的白质脑病的可靠早期征象。然而，我们在此报告首例甲氨蝶呤诱导的白质脑病患者，其DWI上未出现典型的弥散受限情况，并且阐述了磁共振波谱在这种疑难病例（如此处呈现的病例）中对支持该诊断的作用。
