Facial droop left face today, trouble talking since yesterday, bilateral arm numbness. The images are degraded by patient motion. There has been interval evolution of the patchy areas of cerebral white matter T2 hyperintensity, which are generally more conspicuous. However, there is now resolution of the associated restricted diffusion. The ventricles are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull and scalp soft tissues are grossly unremarkable. There are right maxillary sinus retention cysts.
The limited exam demonstrates interval evolution of the cerebral white matter lesions, which may represent methotrexate-related neurotoxicity.