Sjoerd I.P.J. de Faber, Pim G.N.J. Mutsaers, Martin J. van den Bent, Matthijs van der Meulen*

de Faber et al. J Clin Transl Res 2021; 7(6):13

Published online: November 29, 2021


Background and aim: We present a case of a 22 year-old male diagnosed with B-ALL who received intrathecal methotrexate in addition to his systemic chemotherapy regime. During induction treatment he presented with a rapidly progressive bilateral paresis, anarthria, and respiratory insufficiency requiring intubation. The brain MRI showed bilateral lesions with diffusion restriction of the corona radiata/centrum semiovale without other abnormalities. He recovered spontaneously without neurological sequelae. The clinical course combined with the radiological findings are suspect for an intrathecal methotrexate induced leukoencephalopathy.
Relevance for patients: although neurological deficits after intrathecal methotrexate are rare, and in most cases self-limiting, it should be recognized as a cause for rapid neurological decline, after excluding other causes.



Author affiliation

1. Department of Neuro-oncology, Erasmus MC Cancer Institute, Brain Tumor Center, University Medical Centre Rotterdam, Rotterdam, the Netherlands
2. Department of Neurology, HAGA Hospital the Hague, the Netherlands
3. Department of Hematology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, the Netherlands
4. Department of Neurology, Medisch Spectrum Twente, Enschede, the Netherlands

*Corresponding author
Matthijs van der Meulen
Department of Neurology, Medisch Spectrum Twente, P.O. box 50000, 7500 KA Enschede, The Netherlands

Handling editor:
Michal Heger
Department of Pharmaceutics, Utrecht University, the Netherlands
Department of Pharmaceutics, Jiaxing University Medical College, Zhejiang, China


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