Reason: history of ALL s/p high dose methotrexate last week: rule out stroke/neurotoxicity sudden onset left hand tingling and left leg numbness - dragging left foot There is infiltrative diffusion restriction involving the posterior right frontal lobe white matter. There is corresponding mild increased T2/FLAIR signal in this area. In addition, in the left parietal lobe there is subcortical susceptibility within a focus of adjacent nodular susceptibility, without corresponding hyperdensity seen on CT. This may relate to hemosiderin deposition from prior hemorrhage. There is no abnormal enhancement.The gray-white matter differentiation is otherwise preserved. There is no midline shift or mass effect. There is no evidence for hydrocephalus.
1. An infiltrative appearing area of diffusion restriction and FLAIR hyperintensity in the right frontal lobe white matter is suspicious for methotrexate toxicity. Recommend correlation with medical history.2. Left parietal lobe subcortical susceptibility may relate to hemosiderin deposition from prior hemorrhage. No associated discrete mass or enhancement.