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Transient leukoencephalopathy after intrathecal methotrexate mimicking stroke
Amit Agarwal1, Kanupriya Vijay, Krishnamoorthy Thamburaj
1Department of Radiology, Penn State University, Hershey Medical Center, 500 University Drive, Hershey, PA 17036, USA. aagarwal1@hmc.psu.edu
Emergency Radiology
|January 19, 2011
Summary
Intrathecal methotrexate can cause acute neurotoxicity, mimicking stroke. This condition, transient leukoencephalopathy, resolves within weeks, unlike a true stroke.
Area of Science:
- Neuroscience
- Oncology
- Immunology
Background:
- Methotrexate (MTX) is a vital antimetabolite used for oncological and immunological conditions.
- It is administered intravenously or intrathecally, often in combination therapies.
Observation:
- Intrathecal MTX can induce acute neurotoxicity, presenting with confusion, seizures, and focal deficits.
- These symptoms can mimic stroke, showing restricted diffusion on MRI.
Findings:
- The reported cases demonstrate transient leukoencephalopathy following intrathecal methotrexate.
- Both clinical and radiological findings resolved completely within 1-4 weeks.
Implications:
- Recognizing transient leukoencephalopathy is crucial for accurate diagnosis and management.
- This condition's transient nature differentiates it from permanent neurological damage like stroke.
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