Methotrexate-Induced Stroke-Like Encephalopathy: Beware the Stroke Mimic.

We report a case of methotrexate (MTX)-induced stroke-like encephalopathy in an 18-year-old woman, with acute lymphoblastic leukemia, who developed a sudden neurological deficit mimicking a cerebrovascular event. Bain MRI showed hyperintensities on diffusion-weighted-imaging (DWI) with matching apparent diffusion coefficient hypointensities, which also represent the commonest MRI findings in acute cerebral infarction. DWI changes spared the cerebral cortex and did not respect vascular territories, supporting a non-vascular mechanism. MRI plays a crucial role in the diagnostic work-up and is essential to avoid unnecessary intervention such as thrombolytic therapy. Teaching Point: Methotrexate-induced stroke like neurotoxicity should be considered in patients treated with methotrexate and presenting with a stroke-like clinical picture and radiological findings consistent with acute cerebral infarction.

Abdominal CT findings in Puumala hantavirus-infected patients.

BACKGROUND: Previous clinical studies have reported abdominal findings on ultrasonography or MRI in Puumala hantavirus-infected patients. PURPOSE: To determine if abdominal computed tomography (CT) can lead to a diagnosis of Puumala virus infection in the presence of a suggestive clinical picture. MATERIAL AND METHODS: CT findings were studied retrospectively in 30 patients who presented to the emergency department of two (Belgian) hospitals with serologically confirmed Puumala hantavirus infection. RESULTS: The most frequent finding was perirenal fascial thickening (90%), followed by perirenal fat stranding (87%). Retroperitoneal fat stranding was found in 19 patients (64%) in the perivesical spaces along the fascia of the external iliac vessels with or without involvement of the presacral fat. Half of the patients had pelvic ascites, and pleural fluid was found in 7 of them. The right and left mean pole-to-pole kidney's lengths were respectively 125.7 mm and 127.8 mm in 28 patients. CONCLUSION: Retroperitoneal fat stranding, perirenal fascial thickening and/or perirenal fat stranding were found in most patients with acute Puumala virus infection who have undergone CT. Although nonspecific, these findings may help to suggest Puumala hantavirus infection in the right clinical settings.

Simultaneous bilateral optic neuropathy and myelitis revealing paraneoplastic neurological syndrome associated with multiple onconeuronal antibodies.

Paraneoplastic neurological syndromes (PNS) are immune-mediated complications of cancer associated with a broad spectrum of clinical manifestations. Optic neuropathy (ON) and myelitis are frequent manifestations of multiple sclerosis and neuromyelitis optic spectrum disorders but are considered as non-classical in PNS. Here, we report a case of PNS revealed by simultaneous bilateral ON and myelitis related to a cluster of three neural autoantibodies, in the setting of small cell lung cancer.

Splenosis Mimicking Peritoneal Carcinomatosis.

Teaching point: Splenosis must be considered in patients with history of splenectomy or splenic trauma, later presenting with multiple peritoneal nodules.

Cytotoxic Lesion of the Corpus Callosum Caused by Puumala Hantavirus Infection.

We report the case of a 45-year-old male referred to our hospital with fever, asthenia, visual disturbances and increasing headaches. Diffusion-weighted imaging of the brain showed high signal intensity in the splenium of corpus callosum with low apparent diffusion coefficient values. Diagnosis of cytotoxic lesion of corpus callosum was made with Puumala Hantavirus infection serologically confirmed and should not be mistaken for ischemia. Patient was discharged 8 days after admission and imaging findings had resolved 3 weeks later.