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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 unnecessar...
Source: Journal of the Belgian Society of Radiology - October 31, 2022 Category: Radiology Source Type: research

Acute Neurotoxicity during ALL Therapy Is Associated with Treatment Intensity, Age and Female Sex - an Analysis of SAE Reports from the UKALL 2003 Trial
Discussion:This large study identifies treatment intensity as the main risk factor for developing acute neurotoxicity with female sex, age and CNS status having a significant modifying effect. CNS status may reflect increased intrathecal therapy given to non-CNS-1 patients. Females are more vulnerable to cranial radiotherapy induced neurotoxicity but this is the first report of female sex as a risk factor on contemporary chemotherapy treatment protocols. Reassuringly, the occurrence of acute neurotoxicity did not influence survival rates. These data provide an important benchmark for ongoing international deep phenotyping ...
Source: Blood - November 21, 2018 Category: Hematology Authors: Wahid, Q.-u.-A., Hamadeh, L., McGowan, S., Hough, R., Vora, A., Moorman, A. V., Halsey, C. Tags: 612. Acute Lymphoblastic Leukemia: Clinical Studies: Poster I Source Type: research

Methotrexate Encephalopathy as a Cause of Alternating Hemiplegia (P3.143)
CONCLUSIONS: Transient neurologic dysfunction with reversible MRI abnormality is a recognized consequence of intrathecal methotrexate chemotherapy in childhood ALL. Patients present with dramatic fluctuating neurologic symptoms with associated MRI changes and may be mistaken for stroke or a seizure disorder. Once the syndrome is recognized patients typically recover with supportive management and rehabilitation.Disclosure: Dr. Sullivan has nothing to disclose. Dr. Quealy has nothing to disclose. Dr. Olsevskaite has nothing to disclose. Dr. MacEneaney has nothing to disclose. Dr. Ryan has nothing to disclose. Dr. O'Toole ha...
Source: Neurology - April 8, 2015 Category: Neurology Authors: Sullivan, C., Quealy, J., Olsevskaite, J., MacEneaney, P., Ryan, C., O'Toole, O. Tags: Neuro-oncology: CNS Lymphoma and Other Hematologic Malignancies Source Type: research

Methotrexate induced leucoencephalopathy: A stroke mimic
We describe the case of a 17 year old girl with acute lymphoblastic leukemia, who developed stroke like episodes on two consecutive challenges with a chemotherapeutic regime which included intravenous and intrathecal methotrexate. She had MRI changes consistent with acute ischemic stroke on both occasions. Her deficits recovered completely and spontaneously, as did the MRI changes. She did not have any further episodes when methotrexate was excluded from the chemotherapeutic regime.
Source: Annals of Indian Academy of Neurology - August 26, 2013 Category: Neurology Authors: Tushar D GosaviMohammed Tauqeer AhmadLai-Heng LeeShih-Hui Lim Source Type: research