Bilateral refractory subdural hygromas following intrathecal methotrexate injections for B-Cell Acute Lymphocytic Leukemia

Abstract

BackgroundSubdural hygroma (SDG) is an important complication after intrathecal injections of medications. SDG develops because of a cerebrospinal fluid leak into subdural space. Case descriptionWe report a case of 69 years old male who presented to the hospital with changes in mental status and hemodynamic instability. The patient was a known case of B-Cell Acute Lymphoblastic Leukemia (B-ALL) and was undergoing intrathecal injections of methotrexate (MTX) and intensive chemotherapy. Patient focal neurological deficits were correlated with the neuroimaging findings which showed bilateral subdural hygromas. He has received intrathecal injections of MTX almost 6 weeks ago. Surgical drainage of subdural hygroma was done but the refractory nature of hygroma left the patient with residual mass effects and neurological deficits. ConclusionAs physicians, we should be aware of a fatal but rare complication of intrathecal injections and one of them this patient developed as SDG.