Mesial temporal sclerosis after posterior reversible encephalopathy syndrome

Area of Science:

• Neurology
• Oncology
• Pediatrics

Background:

• Mesial temporal sclerosis (MTS) is a common cause of epilepsy, typically associated with specific risk factors.
• Intrathecal methotrexate (IT-MTX) is a chemotherapy agent used for central nervous system malignancies.
• Posterior reversible encephalopathy syndrome (PRES) is a neurological disorder characterized by transient neurological dysfunction.

Observation:

• A pediatric patient with Burkitt lymphoma, lacking typical MTS risk factors, developed PRES and partial complex seizures.
• The patient's symptoms emerged eight days after initiating IT-MTX therapy.
• The patient's condition progressed to intractable temporal lobe epilepsy.

Findings:

• This case presents the first reported instance of IT-MTX and PRES leading to MTS.
• The development of left MTS was confirmed in the patient.
• The patient's epilepsy became refractory to treatment.

Implications:

• This case suggests a potential neurotoxic pathway involving IT-MTX and PRES contributing to MTS.
• Further research is needed to understand the mechanisms linking these conditions.
• This finding may inform treatment strategies and monitoring for pediatric patients receiving IT-MTX.