[Methotrexate-induced stroke-like syndrome: A pediatric case report]

Area of Science:

• Pediatric Oncology
• Neuro-oncology
• Pharmacology

Background:

• Acute lymphoblastic leukemia (ALL) is the most common childhood cancer.
• Intrathecal methotrexate is a key component in ALL treatment, preventing central nervous system relapse.
• Methotrexate inhibits dihydrofolate reductase, but can cause systemic and neurotoxic adverse effects.

Observation:

• An 11-year-old patient with T-cell ALL developed hemiparesis and aphasia 8 days after intrathecal methotrexate.
• Symptoms included faciobrachial hemiparesis and acute onset expressive aphasia.
• These neurological deficits were consistent with a stroke-like syndrome.

Findings:

• The patient was diagnosed with methotrexate-induced subacute encephalopathy.
• Other potential causes of encephalopathy were excluded.
• Symptoms resolved spontaneously and completely, confirming the methotrexate-induced nature of the neurotoxicity.

Implications:

• This case highlights the potential for methotrexate-induced neurotoxicity, even with intrathecal administration.
• Recognizing methotrexate-induced stroke-like syndrome is vital for timely diagnosis and management in pediatric ALL.
• The reversible nature of these symptoms emphasizes the importance of monitoring and supportive care during chemotherapy.