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Transient tetraparesis after intrathecal and high-dose systemic methotrexate
G Massenkeil1, E Späth-Schwalbe, B Flath
1Department of Internal Medicine, Clinic of Hematology and Oncology, University Hospital Charité, Humboldt University, Berlin, Germany.
Annals of Hematology
|December 19, 1998
Summary
Methotrexate (MTX) can cause rare, severe neurological side effects like acute tetraparesis in lymphoma patients. These neurotoxic effects, including white matter lesions, can occur even after treatment completion.
Area of Science:
- Neuro-oncology
- Chemotherapy-induced neurotoxicity
Background:
- Intrathecal chemotherapy and cranial irradiation improve outcomes for acute lymphoblastic leukemia (ALL) and non-Hodgkin's lymphoma (NHL), reducing central nervous system (CNS) relapses.
- Neurologic complications are known sequelae of CNS-directed therapies in these hematologic malignancies.
Observation:
- A young female with diffuse large B-cell lymphoma experienced transient meningeal irritation after intrathecal methotrexate (MTX), cytosine-arabinoside, and dexamethasone.
- Subsequently, she developed acute tetraparesis and motor aphasia following high-dose systemic MTX chemotherapy.
Findings:
- Magnetic resonance imaging (MRI) revealed periventricular white matter lesions consistent with MTX neurotoxicity.
- Radiologic abnormalities persisted despite clinical recovery, demonstrating delayed and potentially lasting CNS changes.
Implications:
- This case highlights the potential for both acute and subacute neurotoxic effects of MTX in lymphoma patients.
- It underscores the importance of recognizing persistent radiologic findings even after clinical symptom resolution in MTX-treated patients.