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Intrathecal Methotrexate Toxicity Resulting in Brain Death due to Generalized Cerebral Edema Case Report
Haoming Pang1, Julie L Chan1, Serguei I Bannykh2
1Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
The Neurohospitalist
|September 23, 2022
Summary
Intrathecal methotrexate (IT MTX) can cause severe cerebral edema, a rare but fatal side effect. This case report details a fatal outcome in a patient with breast cancer receiving IT MTX for leptomeningeal carcinomatosis.
Area of Science:
- Neuro-oncology
- Oncology
- Pharmacology
Background:
- Leptomeningeal carcinomatosis presents a significant challenge in metastatic breast cancer management.
- Intrathecal methotrexate (IT MTX) is a treatment option for leptomeningeal carcinomatosis.
- Severe adverse events associated with IT MTX are not extensively documented.
Observation:
- A 37-year-old BRCA1+ woman with metastatic triple-negative breast cancer received IT MTX.
- Within 24 hours of IT MTX administration, she developed severe, diffuse cerebral edema.
- Neurological decline progressed to uncal and cerebellar tonsillar herniation.
Findings:
- The patient experienced a rare and fatal adverse event following IT MTX.
- Diffuse cerebral edema leading to herniation is a potentially life-threatening complication of IT MTX.
- This case underscores the severe neurotoxicity possible with IT MTX.
Implications:
- Clinicians should be aware of the risk of severe cerebral edema with IT MTX.
- Careful patient selection and monitoring are crucial when administering IT MTX.
- Further investigation into the mechanisms and prevention of IT MTX-induced neurotoxicity is warranted.
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