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Sudden neurologic death after intrathecal methotrexate.
T Shore1, M J Barnett, G L Phillips
1Leukemia and Bone Marrow Transplant Program of British Columbia, Vancouver General Hospital, Canada.
Medical and Pediatric Oncology
|January 1, 1990
Summary
Methotrexate leukoencephalopathy can be fatal, even without typical early symptoms. This case highlights the urgent need for reliable monitoring of central nervous system toxicity from intrathecal methotrexate therapy.
Area of Science:
- Neuroscience
- Oncology
- Pharmacology
Background:
- Methotrexate is a chemotherapy agent used to treat various cancers.
- Intrathecal methotrexate is administered directly into the cerebrospinal fluid to treat or prevent central nervous system involvement of cancer.
- Methotrexate leukoencephalopathy is a known, albeit uncommon, neurotoxic complication of this therapy.
Observation:
- A patient receiving intrathecal methotrexate for leukemic meningitis developed fatal methotrexate leukoencephalopathy.
- The patient did not exhibit the typical prodromal neurologic symptoms or signs of this syndrome.
- Diagnosis was not suspected until post-mortem examination.
Findings:
- The patient experienced brain death after 11 doses of intrathecal methotrexate.
- The absence of a clinical prodrome complicated early recognition and intervention.
- This case represents a fatal outcome of methotrexate-induced neurotoxicity.
Implications:
- There is a critical need for improved methods to monitor for central nervous system toxicity during intrathecal methotrexate treatment.
- Developing a reliable diagnostic test for early detection of methotrexate leukoencephalopathy is essential.
- This underscores the importance of recognizing atypical presentations of treatment-related neurotoxicity in oncology patients.