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A Case of Reversible Cerebral Vasoconstriction Syndrome Triggered by High‐Dose Methotrexate in a Boy With Lymphoma
Author(s) -
Wang Xiaona,
Zhang Yan,
You Hui,
Zhu Tienan,
Zhou Daobin
Publication year - 2020
Publication title -
headache: the journal of head and face pain
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.14
H-Index - 119
eISSN - 1526-4610
pISSN - 0017-8748
DOI - 10.1111/head.13526
Subject(s) - reversible cerebral vasoconstriction syndrome , medicine , posterior reversible encephalopathy syndrome , subarachnoid hemorrhage , anesthesia , headaches , magnetic resonance imaging , radiology , surgery
Background Reversible cerebral vasoconstriction syndrome (RCVS) is characterized by thunderclap headaches and transient segmental cerebral arterial vasoconstriction. Many drugs have been identified as triggers of RCVS. However, RCVS induced by methotrexate (MTX), an antimetabolite agent, has never been reported. Case We report the first case of a 17‐year‐old Chinese student with a thunderclap headache after administration of high‐dose methotrexate during the treatment of extranodal natural killer/T‐cell lymphoma. Brain magnetic resonance angiography showed segmental constriction of the right anterior cerebral artery A1 segment, combined with nonaneurysmal cortical subarachnoid hemorrhage and vasogenic brain edema in brain magnetic resonance imaging. Cerebral images became normal 6 weeks later. Discussion MTX is associated with a variety of neurological toxicities, including aseptic meningitis, transverse myelopathy, acute and subacute encephalopathy, and leukoencephalopathy. However, this is the first report that MTX can trigger RCVS, although it is not a proof for causality. RCVS should be a differential diagnosis for a headache after MTX administration.