Abstract
In this case report; a 12-year-old male with ALL who developed transient left hemiparesis associated with dysphasia and central facial paralysis 14 days after high dose methotrexate (5g/m2) and intrathecal MTX (12 mg, according to age) treatment has been reported. Cranial magnetic resonance imaging (MRI) revealed restricted diffusion in bilateral centrum semiovale compatible with MTX-induced acute encephalopathy. All clinical symptoms resolved completely without any treatment.
 Clinical findings including headache, nausea, emesis, lethargy, altered mental status, blurred vision, aphasia, dysphasia, hemiparesis and cranial MRI findings of restricted diffusion that does not comply with the territory of any artery seizure should alert the physician for MTX-induced acute encephalopathy.
Highlights
Methotrexate (MTX) is an important chemotherapeutic agent in acute lymphoblastic leukemia (ALL) treatment because it has been shown to increase the surveillance in children with ALL
The incidence of acute encephalopathy after MTX treatment was 0.8% for patients with leukemia/lymphoma and 4.5% for patients with osteosarcoma or malignant fibrous histiocytoma [5]. This shows that higher incidences of acute encephalopathy are related to higher doses of MTX that used in the treatment of osteosarcoma or malignant fibrous histiocytoma (8-12 g/m2)
In a study performed by Mahoney et al; cumulative dosage of systemic MTX, a high MTX: leucovorin ratio, and concurrent intrathecal MTX treatment have been shown to increase the risk of acute encephalopathy [9]
Summary
İnci Yaman Bajin 1,*, [MD] ORCID: 0000-0003-1305-4326 Barış Kuşkonmaz 1,[MD] ORCID:0000-0002-1207-4205 Şule Ünal 1, [MD] ORCID: 0000-0001-8795-6299 Selin Aytaç 1,[MD] ORCID: 0000-0003-2132-4605 Mualla Çetin 1,[MD] ORCID: 0000-0002-3005-2288 Selin Ardalı 2,[MD] ORCID: 0000-0002-4907-3230 Kader Karlı Oğuz 2,[MD] ORCID: 0000-0002-3385-4665 Fatma Gümrük 1,[MD] In this case report; a 12-year-old male with acute lymphoblastic leukemia who developed transient left hemiparesis associated with dysphasia and central facial paralysis 14 days after high dose methotrexate (5g/m2) and intrathecal methotrexate (12 mg, according to age) treatment has been reported. Nausea, emesis, lethargy, altered mental status, blurred vision, aphasia, dysphasia, hemiparesis and cranial magnetic resonance imaging findings of restricted diffusion that does not comply with the territory of any artery should alert the physician for methotrexate-induced acute encephalopathy
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