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CC BY-NC-ND 4.0 · Arq Neuropsiquiatr 2018; 76(12): 858-859
DOI: 10.1590/0004-282X20180123
Images in Neurology

Disseminated necrotizing leukoencephalopathy

Leucoencefalopatia necrotizante disseminada
Matthew R. McCann
1   University of Kentucky, Department of Neurology, Lexington, KY, USA
,
Ana C. Albuja
1   University of Kentucky, Department of Neurology, Lexington, KY, USA
,
Mauricio F. Villamar
1   University of Kentucky, Department of Neurology, Lexington, KY, USA
,
Douglas E. Lukins
2   University of Kentucky, Department of Radiology, Lexington, KY, USA
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An 11-year-old boy had a relapse of acute lymphoblastic leukemia involving the CNS. He was treated with whole brain radiotherapy and intrathecal methotrexate. One week after the whole brain radiotherapy, he developed personality changes and right facial weakness. Brain MRI was obtained ([Figure 1]).

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Figure 1 Initial brain MRI. Axial T2-weighted brain MRI shows extensive regions of subcortical hyperintensity with small internal foci of low signal (A). Post-contrast T1-weighted axial MRI shows a necrotic-appearing subcortical enhancement pattern within the anterior temporal and inferior frontal lobes bilaterally (B).

Disseminated necrotizing leukoencephalopathy is an uncommon neurotoxicity syndrome associated with whole brain radiotherapy and methotrexate. Personality change is commonly reported[1]. Disseminated necrotizing leukoencephalopathy is characterized by subcortical T2-hyperintensities with low-signal foci and corresponding contrast-enhancing areas[1],[2]. Early cessation of inciting therapies may prevent progression ([Figure 2]). Our patient returned to his neurologic baseline and at 14-month follow-up remained without further deterioration.

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Figure 2 Follow-up brain MRI. Imaging four months after initial recognition of disseminated necrotizing leukoencephalopathy and cessation of inciting therapies demonstrates interval improvement in edema (A) and reduced extent of contrast enhancement (B).


Publication History

Received: 27 June 2018

Accepted: 08 August 2018

Article published online:
22 August 2023

© 2023. Academia Brasileira de Neurologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • References

  • 1 Oka M, Terae S, Kobayashai R, Sawamura Y, Kudoh K, Tha KK et al. MRI in methotrexate-related leukoencephalopathy: disseminated necrotizing leukoencephalopathy in comparison with mild leukoencephalopathy. Neuroradiology. 2003;45(7):493-7.
  • 2 Laxmi SN, Takahashi S, Matsumoto K, Higan S, Kurihara N, Imaizumi M et al. Treatment-related disseminated necrotizing leukoencephalopathy with characteristic contrast enhancement of the white matter. Radiat Med. 1996 Nov-Dec;14(6):303-7.