Document Detail


Disseminated necrotizing leukoencephalopathy following low-dose oral methotrexate.
MedLine Citation:
PMID:  17355553     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Leukoencephalopathy is a recognized complication with intrathecal or intravenous methotrexate (MTX). We report a 59-year-old lady who developed MTX leukoencephalopathy with long-term low-dose oral MTX. She developed posterior leukoencephalopathy (PLE) that initially was reversible on discontinuation of oral MTX. Four months later, she developed disseminated necrotizing leukoencephalopathy (DNL), and was left with devastating neurological deficits. The sequential conventional magnetic resonance imaging (MRI), diffusion weighted imaging (DWI), MR perfusion (MRP) and MR spectroscopic (MRS) changes are highlighted in this report. MRP and MRS showed more wide spread abnormalities than DWI. Stereotactic biopsy from the lesion revealed demyelination with macrophagic infiltration, pericapillary lymphomononuclear aggregation, fibrinoid changes in the capillaries and neovascularization. Of the two cases of PLE with oral MTX reported in literature, one reversed clinically and radiologically with the discontinuation of MTX. To the best of our knowledge, this is the first reported case of DNL following oral MTX in the world literature.
Authors:
S Raghavendra; M D Nair; T Chemmanam; T Krishnamoorthy; V V Radhakrishnan; A Kuruvilla
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Publication Detail:
Type:  Case Reports; Journal Article    
Journal Detail:
Title:  European journal of neurology : the official journal of the European Federation of Neurological Societies     Volume:  14     ISSN:  1468-1331     ISO Abbreviation:  Eur. J. Neurol.     Publication Date:  2007 Mar 
Date Detail:
Created Date:  2007-03-14     Completed Date:  2007-05-10     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9506311     Medline TA:  Eur J Neurol     Country:  England    
Other Details:
Languages:  eng     Pagination:  309-14     Citation Subset:  IM    
Affiliation:
Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India. raghavneuro@yahoo.com
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MeSH Terms
Descriptor/Qualifier:
Antirheumatic Agents / administration & dosage,  adverse effects
Arthritis, Rheumatoid / drug therapy
Brain Damage, Chronic / chemically induced*,  pathology,  physiopathology
Brain Edema / chemically induced,  pathology,  physiopathology
Cerebral Arteries / drug effects,  pathology,  physiopathology
Cognition Disorders / chemically induced,  pathology,  physiopathology
Dexamethasone / therapeutic use
Diffusion Magnetic Resonance Imaging
Dose-Response Relationship, Drug
Female
Gliosis / chemically induced,  pathology,  physiopathology
Glucocorticoids / therapeutic use
Humans
Methotrexate / administration & dosage,  adverse effects*
Middle Aged
Nerve Fibers, Myelinated / drug effects*,  pathology
Neurodegenerative Diseases / chemically induced*,  pathology,  physiopathology
Telencephalon / drug effects*,  pathology,  radiography
Tomography, X-Ray Computed
Treatment Outcome
Chemical
Reg. No./Substance:
0/Antirheumatic Agents; 0/Glucocorticoids; 50-02-2/Dexamethasone; 59-05-2/Methotrexate

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