Fig. 12
From: MRI characteristics of chemotherapy-related central neurotoxicity: a pictorial review
Intrathecal methotrexate (MTX) administration complicated by epidural hematoma. A 66-year-old man was on an intrathecal MTX regimen for treatment of non-Hodgkin lymphoma, presented with severe back pain that radiates to the left leg after the first week of intrathecal MTX administration. Sagittal T1- (a) and T2-weighted (b) MRI lumbar spine images demonstrate a posterior epidural collection of iso to slightly high T1 and mixed heterogeneous T2 signal intensities, compressing the thecal sac with crowding of cauda equina (arrows). Axial T2WI (c) shows corresponding high T2 intensity epidural collection compressing the right posterolateral aspect of the thecal sac (thick arrow). Axial T1W post-contrast image reveals no abnormal enhancement. The findings are consistent with an epidural hematoma. Besides, there is an old compression fracture of the L1 vertebral body which has been stable since the prior study (not shown). Patient underwent an urgent laminectomy and evacuation of the epidural hematoma with subsequent improvement of his symptoms