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Characteristics of methotrexate-induced stroke-like neurotoxicity.
Abstract Intrathecal administration of methotrexate (IT-MTX) can lead to neurotoxicity. MTX-induced neurotoxicity occasionally manifests with a stroke-like presentation that is difficult to distinguish from genuine stroke. We retrospectively reviewed records of nine patients with leukemia or lymphoma and episodes of stroke-like presentation at our institute between 2010 and 2015 for whom magnetic resonance imaging (MRI) data were available. Coagulation test results were compared between the two diagnostic groups. Four patients were diagnosed with MTX-induced stroke-like neurotoxicity. The first neurological event ...
Source: International Journal of Hematology - September 4, 2018 Category: Hematology Authors: Watanabe K, Arakawa Y, Oguma E, Uehara T, Yanagi M, Oyama C, Ikeda Y, Sasaki K, Isobe K, Mori M, Hanada R, Koh K Tags: Int J Hematol Source Type: research

Methotrexate Neurotoxicity Mimicking Stroke (P2.296)
Conclusion: It is important for clinicians to recognize methotrexate-induced neurotoxcity as a possible stroke mimic.Disclosure: Dr. Pham has nothing to disclose. Dr. Ermak has nothing to disclose.
Source: Neurology - April 8, 2015 Category: Neurology Authors: Pham, Q., Ermak, D. Tags: Cerebrovascular Disease and Interventional Neurology: Inflammation and Immunology Source Type: research

Hyperleukocytosis-induced stroke and tonsillar herniation: Case report
CONCLUSION: This case demonstrate the value of early recognition and prompt management of posterior circulation ischemic stroke in children with leukemia and hyperleukocytosis at presentation.PMID:34540210 | PMC:PMC8441068 | DOI:10.1016/j.amsu.2021.102776
Source: Annals of Medicine - September 20, 2021 Category: Internal Medicine Authors: Hasan Hashem Baha'eddin A Muhsen Source Type: research

A Unique Presentation of Pediatric Stroke Attributed to Intrathecal Methotrexate (P3.309)
CONCLUSIONS:This is a rare case of ischemic watershed infarcts with diffuse reversible cerebral vasospasm, after intrathecal methotrexate. This highlights the need for further research into the pathogenesis of methotrexate neurotoxicity including endothelial damage.Study Supported by:Disclosure: Dr. Ilyas has nothing to disclose. Dr. Williams has nothing to disclose.
Source: Neurology - April 9, 2014 Category: Neurology Authors: Ilyas, M., Williams, M. Tags: Neurologic Complications of Cancer Source Type: research

Listeria monocytogenes Meningoencephalitis Mimicking Stroke in a Patient with Chronic Lymphocytic Leukemia
Conclusion The supratentorial focal lesions secondary to Listeria meningoencephalitis are rare. The cases with focal neurological signs without fever at onset can resemble stroke.
Source: Neurology and Therapy - December 1, 2013 Category: Neurology Source Type: research

A Not Uncommon Cause of Stroke Mimicker in Children
A 16 year old young man with history of acute lymphoblastic leukemia presented with acute onset of right hemibody and facial numbness, which progressed to right sided weakness(arm>leg), right facial droop, and aphasia. A stroke alert code was activated and brain magnetic resonance imaging (MRI) revealed focal areas of restricted diffusion in the centrum semiovale bilaterally, slightly more extensively on the left than the right (figure 1). MR angiogram of the head and neck was unremarkable.
Source: Pediatric Neurology - November 13, 2017 Category: Neurology Authors: Erin Willis, Debopam Samanta, Alisa Kanfi Tags: Visual Diagnosis Source Type: research

Evaluation and Management of Acute-Onset Hemiparesis in an Adolescent With Leukemia
We present a case of a 15-year-old boy with pre-B acute lymphoblastic leukemia on chemotherapy, having recently received a high-dose methotrexate infusion in addition to intrathecal methotrexate therapy, who presented to our ED with acute right-sided hemiparesis. He was initially suspected as having a possible ischemic stroke. Magnetic resonance imaging (diffusion-weighted and fluid-attenuated inversion recovery sequence) demonstrated focal areas of diffusion restriction, an early sign of delayed-onset methotrexate neurotoxicity. Our patient received appropriate supportive care and leucovorin rescue with gradual clinical r...
Source: Pediatric Emergency Care - March 1, 2018 Category: Emergency Medicine Tags: Illustrative Cases Source Type: research

Venous thromboembolism in children with acute lymphoblastic leukemia
Abstract Venous thromboembolism (VTE) occurs in 0.95–36 % of children with acute lymphoblastic leukemia almost exclusively during chemotherapy. It is most commonly associated with concurrent l-asparaginase and steroid therapy, central venous line use, and inherited thrombophilia. Clinical manifestations regarding the location of VTE include central nervous system thrombosis (sinus venous thrombosis, cerebral infarct/stroke), upper-/lower-limb deep venous thrombosis, pulmonary embolism, and right atrial/intracardiac and superficial venous thrombosis and can be both symptomatic and asymptomatic. The majority of ...
Source: Memo - Magazine of European Medical Oncology - September 1, 2014 Category: Cancer & Oncology Source Type: research

Transient ischemic attack as an unusual initial manifestation of acute promyelocytic leukemia.
Abstract Patients with acute promyelocytic leukemia (APL) are prone to both bleeding and thrombosis. Both of these have a significant impact on the morbidity and mortality of patients with this disease. Here we report a case of a 41-year-old male, who presented with transient ischemic attack (TIA) and early neurological deterioration (END) as initial manifestations prior to an ultimate diagnosis of APL. This patient had no cerebrovascular risk factors or familial cerebrovascular disease. The patient experienced an acute ischemic stroke, verified by magnetic resonance imaging (MRI), in less than 24 h after his sec...
Source: International Journal of Hematology - March 16, 2016 Category: Hematology Authors: Liu L, Yuan X Tags: Int J Hematol Source Type: research

Reflections on the Future of Medicine
Recently, I traveled through China. I climbed mountains, hiked through forests, crossed deep valleys. I visited cities of every size. I floated across lakes and traveled beautiful shorelines churning with life. As a man of a certain age, I began to compare the permanence of the timeless landscape with the evanescence of my own existence. Yet, as a scientist, I knew these reflections were flawed. Scientists are trained to think in terms of aeons, millenia, and lifetimes. Consider the paradox. Is it the solid mountain or fragile the forest that is permanent? Is it the massive shoreline cliffs or the teeming shore life that...
Source: Science - The Huffington Post - January 9, 2017 Category: Science Source Type: news

A Case of ALL Developing Posterior Reversible Encephalopathy Secondary to Hyponatremia
We describe a case of acute lymphoblastic leukemia in which PRES developed secondary to hyponatremia despite being normotensive during receipt of chemotherapy. Magnetic resonance imaging findings were suggestive of PRES. Partial diffusion restriction was observed in lesions in the bilateral occipitoparietal regions and the cerebellum. The patient was treated with appropriate medications with the resolution of his stroke-like symptoms. No neurological deficit was observed and clinical condition improved. The patient continued with chemotherapy. Early diagnosis and treatment of this syndrome is important in terms of preventi...
Source: Journal of Pediatric Hematology Oncology - October 26, 2017 Category: Hematology Tags: Online Articles: Clinical and Laboratory Observations Source Type: research

Lower-extremity Dynamometry as a Novel Outcome Measure in a Double-blind, Placebo-controlled, Feasibility Trial of Intravenous Immunoglobulin (IVIG) for HIV-associated Myelopathy
Conclusion: We conclude that an adequately powered clinical trial of IVIG for HIVM would likely require a prolonged recruitment period and multiple participating sites. Lower limb dynamometry is a useful outcome measure for HIVM, which might also be useful in other HIV-related gait disorders. KEYWORDS: Dynamometry, intravenous immunoglobulin (IVIG), human immunodeficiency virus (HIV), myelopathy INTRODUCTION Human immunodeficiency virus (HIV)-associated myelopathy (HIVM) is a rare but well-described neurologic complication of HIV; it was first described early in the acquired immunodeficiency syndrome (AIDS) epidemic, and i...
Source: Innovations in Clinical Neuroscience - February 1, 2018 Category: Neuroscience Authors: ICN Online Editor Tags: Assessment Tools Current Issue Demyelinating Disease Movement Disorders Neurodegenerative Disease Neurology Original Research Primary Care Technology Trial Methodology Dynamometry human immunodeficiency virus (HIV) intravenous immu Source Type: research

A Case of Multiple Sclerosis —Like Relapsing Remitting Encephalomyelitis Following Allogeneic Hematopoietic Stem Cell Transplantation and a Review of the Published Literature
Complications involving the central nervous system (CNS) occur in 9–14% of patients following allogeneic hematopoietic stem cell transplantation (HSCT), including stroke-like episodes, demyelination, encephalitis, and nonspecific neurological symptoms. Here we report a case of multiple sclerosis (MS) like relapsing remitting encephalomyelitis following allogeneic HSCT, which did not respond to disease modifying therapies (DMTs) and “domino” autologous HSCT. A 53-year-old male was treated with allogeneic HSCT for lymphoid blast transformation of chronic myeloid leukemia. Ten months later he presented with confusion, s...
Source: Frontiers in Immunology - May 4, 2020 Category: Allergy & Immunology Source Type: research