Fig. 7
A 14-year-old female known to have ALL, in her consolidation phase of chemotherapy treatment (high dose methotrexate, IV vincristine, IV cyclophosphamide, 6-mercaptopurine and intrathecal methotrexate, hydrocortisone, ARA C), she developed right-sided pain that progressed to right-side weakness involving upper and lower limbs. MRI was done 2 days after presentation. MRI revealed: bilateral symmetrical centrum semiovale areas of high signal in DWI (d) (short white arrows) and low signal in ADC (e) (long white arrows) denoting diffusion restriction, and this signal is hardly detected in T2 and FLAIR (b and c) images, not appreciated in all other pulse sequences as T1 (a). The MRI findings together with clinical data are consistent with methotrexate neurotoxicity