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[Hemiparesis and facial palsy caused by methotrexate]
E Rueda Arenas1, J García Corzo, L Franco Ospina
1Servicio de Oncología Pediátrica, Departamento de Pediatría, Universidad Industrial de Santander, Servicio de Oncología Pediátrica Hospital Universitario de Santander, Bucaramanga, Colombia.
Anales De Pediatria (Barcelona, Spain : 2003)
|June 22, 2013
Summary
Methotrexate treatment for acute lymphocytic leukemia can cause rare neurotoxicity. Two teenagers experienced temporary hemiparesis and related symptoms, which quickly resolved without central nervous system involvement or stroke.
Area of Science:
- Neuroscience
- Oncology
- Pharmacology
Background:
- Methotrexate is a key chemotherapy agent for acute lymphocytic leukemia (ALL).
- Methotrexate-induced neurotoxicity is a known but uncommon adverse effect.
- Focal neurological deficits are a rare presentation of this neurotoxicity.
Observation:
- Two adolescent patients undergoing ALL treatment developed acute hemiparesis, facial paresis, and dysarthria.
- These neurological symptoms occurred during the 'M phase' of their treatment protocol.
- The neurological deficits were transient and rapidly reversed.
Findings:
- Cerebrospinal fluid analysis and neuroimaging ruled out central nervous system leukemia or stroke.
- The clinical presentation and rapid recovery suggest a reversible methotrexate-induced neurotoxic mechanism.
- Review of pathophysiology highlights potential mechanisms for focal neurological deficits.
Implications:
- This case highlights a rare but reversible neurotoxic presentation of methotrexate in ALL patients.
- Awareness of this potential side effect is crucial for timely diagnosis and management.
- Further research into the specific pathophysiology of focal methotrexate neurotoxicity is warranted.
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