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Academia Mexicana de Neurología, A.C.

2018, Number 5

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Rev Mex Neuroci 2018; 19 (5)

Neurotoxicity of intrathecal methotrexate related to dementia, ataxia and autonomic system dysfunction. Case report

Ochoa-Mena JD, Arce-Salinas CA

Language: Spanish
References: 29
Page: 68-72
PDF size: 205.60 Kb.


ABSTRACT

The intrathecal methotrexate is used in various hematological neoplasms that involves the central nervous system. The description of neurotoxicity has been performed predominantly in the pediatric population for decades, with a clinical spectrum mostly subacute and reversible, since focal neurological deficit until progressive and irreversible encephalopathy. The changes in magnetic resonance in most reports have been leukoencephalopathy and occasionally cerebellar lesions have been described, however there are no reports of brainstem and cerebellum atrophy. We present the case of a 55-year-old woman who was diagnosed with diffuse B-cell non-Hodgkin lymphoma treated with intravenous rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone and intrathecal methotrexate chemotherapy cycles at recurrent doses due to suspicion of cerebral infiltration of the disease, with subsequent clinical symptoms an radiologic findings similar to brainstem and cerebellum atrophy. Methotrexate neurotoxicity affected multiple regions of the brain causing atrophy and was related to the clinical syndrome as irreversible sequelae.


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