[A case of subacute transient cerebral dysfunction in a osteosarcoma patient following high-dose methotrexate]

Subacute transient cerebral dysfunction following high-dose methotrexate occurred during neo-adjuvant chemotherapy for an eighteen-year-old male with osteosarcoma in his right femur. The variety of symptoms including hemiparesis and hesitancy of speech occurred 8 days after an administration of high-dose methotrexate (10 g/m2). Evaluations including CT scan of the brain, hemogram and blood chemistry revealed no abnormal findings. The patient found it difficult to sit, speak and eat, but was not confused. He improved in a few days without any specific treatment or residual sequelae. This syndrome was transient and did not recur when he had two additional HD-MTX treatments. The cause of this syndrome remains unknown and does not seem to be predictable. It is, thus, necessary for oncologists to take due care with regard to this syndrome in HD-MTX chemotherapy.