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Washington University Experience | MYELIN (NON-IMMUNE MEDIATED) | Necrotizing Leukoencephalopathy | 5A1 DNL (Case 5) ALL Rx, MTX local to WM & RAD gross 8
5A1-6 At the time of death the damage was particularly severe and hemorrhagic on the right side after the catheter was misplaced and the methotrexate was inadvertently administered directly into the right sided parietal parenchyma. Other cases have also described the greatest parenchymal injury surrounding a leaky or misplaced ventriculostomy tube used to administer CSF methotrexate via an Ommaya reservoir. ---- 5A1-3 Although the right hemisphere presents a more spectacular pathology, the white matter of the left hemisphere has a more typical DNL appearance.
