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Nerve Excitability Assessment in Chemotherapy-induced Neurotoxicity
Published on: April 26, 2012
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A Stroke Mimic: Methotrexate-induced Neurotoxicity in the Emergency Department
Patrick Rogers1, Wilbur J Pan2, Richard A Drachtman2
1Department of Emergency Medicine, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey.
The Journal of Emergency Medicine
|January 18, 2017
Summary
Methotrexate therapy for acute lymphoblastic leukemia can cause neurotoxicity, presenting as stroke-like symptoms. Prompt recognition and treatment with dextromethorphan led to rapid recovery in a young woman, highlighting the importance of awareness for emergency physicians.
Area of Science:
- Neurology
- Oncology
- Emergency Medicine
Background:
- Acute lymphoblastic leukemia (ALL) is a common childhood cancer requiring multimodality therapy.
- Methotrexate (MTX) is a crucial chemotherapeutic agent in ALL treatment.
- MTX therapy can lead to various forms of neurotoxicity, ranging from mild symptoms to severe neurological deficits.
Observation:
- An 18-year-old female with a history of ALL presented with acute onset of right-sided hemiparesis and facial paralysis.
- Symptoms appeared three days after receiving MTX therapy.
- Neurological examination revealed flaccid paralysis and weakness consistent with a stroke-like presentation.
Findings:
- Diagnostic workup was unremarkable, ruling out acute cerebrovascular accidents.
- The patient was treated with oral dextromethorphan for presumed MTX-induced neurotoxicity.
- Neurological symptoms showed significant improvement within hours of dextromethorphan administration.
Implications:
- Emergency physicians must consider MTX-induced neurotoxicity in patients with ALL presenting with acute neurological deficits.
- Timely diagnosis and appropriate intervention, such as dextromethorphan, can prevent misdiagnosis and unnecessary treatments like thrombolytics.
- Awareness of this potential complication is critical for effective management and improved patient outcomes in oncology emergencies.
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