Document Detail

Transient encephalopathy following a single exposure of high-dose methotrexate in a child with acute lymphoblastic leukemia.
MedLine Citation:
PMID:  1381940     Owner:  NLM     Status:  MEDLINE    
An episode of transient encephalopathy after the first course of intravenous high-dose methotrexate (HD-MTX; 1000 mg/m2) was observed in a 4-year-old girl with acute lymphoblastic leukemia. The neurological abnormalities took place 5 days after HD-MTX therapy. She experienced complex partial seizure and left hemiparesis, which resolved spontaneously in 5 days. Cranial computed tomographic scan and magnetic resonance imaging showed multiple low-density lesions in bilateral hemispheres. It is well appreciated that neurotoxicity from MTX follows prolonged exposures, often accompanying or following radiation therapy. To our knowledge, however, there have been no reports that such neurological complications developed following a single exposure of HD-MTX in patients with ALL. Follow-up electroencephalograms showed that she had periodic lateralized epileptiform discharges (PLEDS), suggesting functional deafferentation of cortical neurons following HD-MTX. Moreover, the serum and CSF MTX levels following a second low-dose course and her clinical course suggested that she had presumably central nervous system leukemia at the time of HD-MTX therapy, which might have been related to neurological complications. The pathogenesis of MTX-induced neurotoxicity is discussed.
M Kubo; E Azuma; S Arai; Y Komada; M Ito; M Sakurai
Publication Detail:
Type:  Case Reports; Journal Article    
Journal Detail:
Title:  Pediatric hematology and oncology     Volume:  9     ISSN:  0888-0018     ISO Abbreviation:  Pediatr Hematol Oncol     Publication Date:    1992 Apr-Jun
Date Detail:
Created Date:  1992-10-22     Completed Date:  1992-10-22     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  8700164     Medline TA:  Pediatr Hematol Oncol     Country:  ENGLAND    
Other Details:
Languages:  eng     Pagination:  157-65     Citation Subset:  IM    
Department of Pediatrics, Mie University School of Medicine, Japan.
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MeSH Terms
Antineoplastic Combined Chemotherapy Protocols / therapeutic use
Bleomycin / administration & dosage
Child, Preschool
Cyclophosphamide / administration & dosage
Cytarabine / administration & dosage
Dexamethasone / administration & dosage
Doxorubicin / administration & dosage
Epilepsy, Complex Partial / chemically induced*,  pathology
Hydrocortisone / administration & dosage
Injections, Spinal
Leucovorin / administration & dosage
Magnetic Resonance Imaging
Methotrexate / administration & dosage,  adverse effects*
Precursor Cell Lymphoblastic Leukemia-Lymphoma / drug therapy*
Prednisone / administration & dosage
Vincristine / administration & dosage
Reg. No./Substance:
11056-06-7/Bleomycin; 147-94-4/Cytarabine; 23214-92-8/Doxorubicin; 50-02-2/Dexamethasone; 50-18-0/Cyclophosphamide; 50-23-7/Hydrocortisone; 53-03-2/Prednisone; 57-22-7/Vincristine; 58-05-9/Leucovorin; 59-05-2/Methotrexate

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