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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

The Clinical Impact of Methotrexate-Induced Stroke-Like Neurotoxicity in Paediatric Departments: An Italian Multi-Centre Case-Series
ConclusionsSLS is a rare, well-characterized complication of MTX administration. Despite the small sample, we have been able to confirm some of the previous findings in literature. We also identified a linear correlation between age and severity of the disease, which could improve the future clinical management.
Source: Frontiers in Neurology - June 10, 2022 Category: Neurology Source Type: research

Severe, Fatal Methotrexate-related Neurotoxicity in 2 Adolescent Patients With ALL
Neurotoxicity is a well-documented adverse effect of methotrexate in the treatment of pediatric cancers. The spectrum of symptoms is broad, can include stroke-like episodes and seizures, and classically resolves within days. The majority of patients tolerate subsequent doses without recurrence of symptoms. The population of patients who experience persistent and irreversible neurologic symptoms is poorly described, with the existing literature suggestive of a relationship with radiation therapy. The authors present a case series of 2 patients with pre-B-cell acute lymphoblastic leukemia who developed severe and ultimately ...
Source: Journal of Pediatric Hematology Oncology - October 23, 2020 Category: Hematology Tags: Online Articles: Clinical and Laboratory Observations Source Type: research

Prevalence of leukoencephalopathy and its potential cognitive sequelae in cancer patients.
In conclusion, leukoencephalopathy is well-documented for ALL patients (with a focus on methotrexate), but there is a lack of knowledge for other intravenous chemotherapeutics, other oncological populations, wider age ranges and possible risk factors (e.g. history of CNS event). Furthermore, the long-term neuropsychological impact and potential risk for neurodegenerative processes due to leukoencephalopathy remains inconclusive. Hence, large international databanks, epidemiological and prospective case-control studies are necessary to stratify risk groups for CNS-related side effects. PMID: 32799637 [PubMed - as supplied by publisher]
Source: Journal of Chemotherapy - August 19, 2020 Category: Cancer & Oncology Tags: J Chemother 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

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

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

Acute methotrexate-related neurotoxicity and pseudo-stroke syndrome.
We describe five episodes of transient acute leukoencephalopathy mimicking a stroke, reported in the literature as "pseudo-stroke syndrome". Neurologic symptoms occurred 3-10 days after IV or IT methotrexate and manifested as aphasia and alternating sensorimotor deficit. The fluctuating symptomatology regressed completely within a few days. Brain MRI, which is essential for diagnosis, demonstrated early white matter diffusion restriction in the affected cerebral area. These anomalies disappeared in one week, while hyperintense T2 FLAIR signals developed in the corresponding brain areas. The long-term progression of thes...
Source: Archives de Pediatrie - November 13, 2017 Category: Pediatrics Authors: Deneux V, Leboucq N, Saumet L, Haouy S, Akbaraly T, Sirvent N Tags: Arch Pediatr Source Type: research

Investigating the Mechanisms of Methotrexate Neurotoxicity in Patients With Childhood Leukemia and Long-Term Survivors
Adverse neurological events are common (4-20%) during treatment for pediatric acute lymphoblastic leukaemia (ALL) and include seizures, stroke like syndrome and leukoencephalopathy. In addition, chronic neurotoxicity is emerging as a worrying late effect of treatment with long-term survivors experiencing decreased executive function, processing speed and memory function. Survivors are also at increased risk of experiencing learning difficulties, social withdrawal issues and inattention hyperactivity disorders.
Source: Clinical Lymphoma, Myeloma and Leukemia - September 1, 2017 Category: Hematology Authors: Victoria Forster, Jane Carr-Wilkinson, Deborah Tweddle, Sirintra Nakjang, Sanaa Choufani, Rosanna Weksberg, Frederik van Delft Source Type: research

Stroke like syndrome and simple partial seizures secondary to intrathecal methotrexate use for the treatment of acute lymphocytic leukemia. (p6.181)
Conclusions:Our case may be the first reported of seizures and stroke like syndrome in the same patient for ALL treated with MTX. Clinicians should include Methotrexate induced leukoencephalopathy in their differential of seizures, stroke like syndrome and a combination of both. MRI DWI, ADC and FLAIR images should be included in the diagnostic evaluation of MTX induced encephalopathy especially with IT methotrexate.Disclosure: Dr. Fares has nothing to disclose. Dr. Silliman has received research support from Sanofi Genzyme, Biogen Idec, Bristol Myers and Novartis.
Source: Neurology - April 17, 2017 Category: Neurology Authors: Fares, M.-A., Silliman, S. Tags: Neurologic Complications of Cancer Source Type: research

A Stroke Mimic: Methotrexate-induced Neurotoxicity in the Emergency Department
Acute lymphoblastic leukemia (ALL) is the most common form of childhood leukemia. The treatment of ALL involves multimodality therapy, and methotrexate (MTX) remains a mainstay of treatment. A complication of MTX therapy includes acute, subacute, and chronic neurotoxocity. Signs and symptoms may range from headaches, dizziness, and mood disorders to seizures and stroke-like symptoms.
Source: The Journal of Emergency Medicine - January 13, 2017 Category: Emergency Medicine Authors: Patrick Rogers, Wilbur J. Pan, Richard A. Drachtman, Christopher Haines Tags: Clinical Communications: Pediatric Source Type: research

Stroke-like encephalopathy following high-dose intravenous methotrexate in an adolescent with osteosarcoma: a case report
ABSTRACT Chronic lymphocytic leukemia is characterized by clonal proliferation and progressive accumulation of B-cell lymphocytes that typically express CD19+, CD5+ and CD23+. The lymphocytes usually infiltrate the bone marrow, peripheral blood, lymph nodes, and spleen. The diagnosis is established by immunophenotyping circulating B-lymphocytes, and prognosis is defined by two staging systems (Rai and Binet) established by physical examination and blood counts, as well as by several biological and genetic markers. In this update, we present the recommendations from the Brazilian Group of Chronic Lymphocytic Leukemia for th...
Source: Revista Brasileira de Hematologia e Hemoterapia - December 29, 2016 Category: Hematology Source Type: research

Cervical aspergillosis with dissemination to the central nervous system: Case reports and review of the literature.
CONCLUSION: IA must be considered a possibility whenever an immunocompromised patient presents with a new brain lesion. These lesions require surgical evacuation, a procedure that allows for diagnostic confirmation and enhances prognosis. Appropriate anti-fungal therapy must be started as soon as the diagnosis is confirmed. In addition, the patient's neurological exam must be repeated and images obtained periodically to monitor treatment and detect possible recurrences. PMID: 26600985 [PubMed - as supplied by publisher]
Source: Surgical Neurology International - November 25, 2015 Category: Neurosurgery Tags: Surg Neurol Int 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 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

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