Benkirane Adam, Mulquin Nicolas, London Frédéric
CHU UCL Namur site Godinne, BE.
J Belg Soc Radiol. 2022 Oct 31;106(1):98. doi: 10.5334/jbsr.2935. eCollection 2022.
We report a case of methotrexate (MTX)-induced stroke-like encephalopathy in an 18-year-old woman, with acute lymphoblastic leukemia, who developed a sudden neurological deficit mimicking a cerebrovascular event. Bain MRI showed hyperintensities on diffusion-weighted-imaging (DWI) with matching apparent diffusion coefficient hypointensities, which also represent the commonest MRI findings in acute cerebral infarction. DWI changes spared the cerebral cortex and did not respect vascular territories, supporting a non-vascular mechanism. MRI plays a crucial role in the diagnostic work-up and is essential to avoid unnecessary intervention such as thrombolytic therapy. Methotrexate-induced stroke like neurotoxicity should be considered in patients treated with methotrexate and presenting with a stroke-like clinical picture and radiological findings consistent with acute cerebral infarction.
我们报告了一例18岁急性淋巴细胞白血病女性患者发生甲氨蝶呤（MTX）诱导的类中风性脑病，该患者突然出现类似脑血管事件的神经功能缺损。脑部MRI在扩散加权成像（DWI）上显示高信号，表观扩散系数呈相应低信号，这也是急性脑梗死最常见的MRI表现。DWI改变未累及大脑皮质，且不按血管分布区域，支持非血管机制。MRI在诊断检查中起关键作用，对于避免不必要的干预（如溶栓治疗）至关重要。对于接受甲氨蝶呤治疗且出现类似中风临床表现及与急性脑梗死相符的影像学表现的患者，应考虑甲氨蝶呤诱导的类中风神经毒性。
