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Recurrent intrathecal methotrexate induced neurotoxicity in an adolescent with acute lymphoblastic leukemia: Serial clinical and radiologic findings
Author(s) -
Brugnoletti Fulvia,
Morris E. Bran,
Laningham Fred H.,
Patay Zoltán,
Pauley Jennifer L.,
Pui ChingHon,
Jeha Sima,
Inaba Hiroto
Publication year - 2009
Publication title -
pediatric blood and cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.116
H-Index - 105
eISSN - 1545-5017
pISSN - 1545-5009
DOI - 10.1002/pbc.21764
Subject(s) - medicine , methotrexate , neurotoxicity , magnetic resonance imaging , white matter , acute lymphocytic leukemia , lesion , toxicity , lymphoblastic leukemia , anesthesia , oncology , leukemia , pathology , radiology
Systemic and intrathecal methotrexate (MTX) are integral components of acute lymphoblastic leukemia (ALL) therapy, but can be associated with neurotoxicity. We describe here the case of an adolescent male with T‐cell ALL who developed recurrent episodes of subacute neurotoxicity characterized by slurred speech, emotional lability, and hemiparesis after intrathecal MTX administration. Serial magnetic resonance imaging with diffusion‐weighted imaging showed recurrent areas of restricted diffusion within cerebral hemispheric white matter, which correlated chronologically with the administration of intrathecal therapy and severity of clinical symptoms. Resolution of diffusion abnormalities did not preclude further toxicity and a large lesion could cause persisting symptoms. Pediatr Blood Cancer 2009;52:293–295. © 2008 Wiley‐Liss, Inc.