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. Author manuscript; available in PMC: 2021 Nov 1.
Published in final edited form as: J Pediatr Hematol Oncol. 2020 Nov;42(8):e839–e844. doi: 10.1097/MPH.0000000000001706

FIGURE 2.

FIGURE 2.

Case 2, a 20-year-old Hispanic woman being treated for pre-B-ALL CNS2 developed altered mental status 9 days after the last dose of ITT MTX during induction chemotherapy. She developed agitation, inappropriate laughter, and full-body paresthesias. An MRI showed bilateral restricted diffusion in the centrum semiovale and left precentral regions without associated T2/FLAIR hyperintensities initially (A). Five days later, she demonstrated progressively restricted diffusion within the centrum semiovale (B). A repeat MRI 28 days into her symptoms showed extensive T2/FLAIR changes in the corona radiate and centrum semiovale of both cerebral hemispheres, with no evidence of restricted diffusion (C). ADC indicates apparent diffusion coefficient; ALL, acute lymphoblastic leukemia; CNS2, central nervous system < 5 leukocytes with blasts present; DWI, diffusion-weighted imaging; FLAIR, fluid-attenuated inversion recovery; ITT, intrathecal triple therapy; MRI, magnetic resonance imaging; MTX, methotrexate.