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High dose systemic methotrexate-associated acute neurologic dysfunction.

R J Packer, R I Grossman, J B Belasco

    Medical and Pediatric Oncology
    |January 1, 1983
    PubMed
    Summary
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    High-dose methotrexate with citrovorum rescue (HDMTX-CF) can cause acute neurologic deficits in osteosarcoma patients. These deficits, including hemiparesis, typically resolve within 72 hours with no lasting effects.

    Area of Science:

    • Pediatric Oncology
    • Neuro-oncology
    • Pharmacology

    Background:

    • High-dose methotrexate with citrovorum rescue (HDMTX-CF) is a critical chemotherapy regimen for osteosarcoma.
    • Neurologic complications are rare but serious adverse events associated with HDMTX-CF.

    Observation:

    • Two pediatric patients receiving HDMTX-CF for osteosarcoma presented with acute neurologic deficits.
    • Symptoms included altered consciousness and hemiparesis, with subsequent steady improvement over 72 hours.

    Findings:

    • Laboratory tests revealed normal coagulation and non-toxic serum methotrexate levels at symptom onset.
    • Computed tomography identified a significant low-absorption abnormality in one patient, marking the first reported radiologic evidence of this syndrome.
    • Both patients recovered fully and tolerated subsequent HDMTX-CF treatment without recurrence.

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    Implications:

    • The findings suggest that HDMTX-CF-induced neurologic deficits may stem from transient demyelination or embolic cerebrovascular events.
    • This syndrome, though rare, requires careful monitoring in patients undergoing HDMTX-CF therapy.
    • Early recognition and understanding of potential radiologic findings are crucial for patient management.