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Academia Mexicana de Neurología, A.C.

2018, Número 5

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Rev Mex Neuroci 2018; 19 (5)


Neurotoxicidad del metotrexato intratecal relacionado con demencia, ataxia y disfunción del sistema autónomo. Reporte de un caso

Ochoa-Mena JD, Arce-Salinas CA

Idioma: Español
Referencias bibliográficas: 29
Paginas: 68-72
Archivo PDF: 205.60 Kb.


RESUMEN

El metotrexato intratecal se emplea en diversas neoplasias hematológicas que involucran al sistema nervioso central. La descripción de la neurotoxicidad es en su mayoría subaguda y reversible, y el espectro clínico es variable, desde déficit neurológico focal hasta encefalopatía progresiva e irreversible. Los cambios en la resonancia magnética son leucoencefalopatía y lesiones en el cerebelo. Se presenta el caso de una mujer de 55 años con linfoma no Hodgkin de células B manejada con esquema R-CHOP (rituximab, ciclofosfamida, clorhidrato de doxorubicina [hidroxidaunorubicina], sulfato de vincristina [oncovin] y prednisona) y metotrexato intratecal por sospecha de infiltración cerebral de la enfermedad, con desarrollo posterior de ataxia, demencia y disautonomía, y neuroimagen con atrofia cerebelosa y del tallo cerebral. La neurotoxicidad por metotrexato afectó a múltiples regiones del encéfalo, causó disfunción grave y se relacionó al cuadro clínico como secuela irreversible.


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