Article ; Online: Myelopathy associated with intrathecal methotrexate.
2021 Volume 22, Issue 2, Page(s) 141–144
Abstract: A 21-year-old man developed progressive and bilateral lower limb numbness, gait impairment and urinary incontinence over 10 days. He had received intrathecal methotrexate 20 days previously for acute lymphoblastic B-cell leukaemia, following 7 months of ... ...
| Abstract | A 21-year-old man developed progressive and bilateral lower limb numbness, gait impairment and urinary incontinence over 10 days. He had received intrathecal methotrexate 20 days previously for acute lymphoblastic B-cell leukaemia, following 7 months of systemic chemotherapy. MR scan of the spinal cord showed bilateral symmetric and extensive T2/fluid attenuated inversion recovery (FLAIR) increased signal involving the dorsal columns in the thoracic cord. His serum folate concentration was at the lower end of the normal range. We stopped the intrathecal chemotherapy and gave folate; after a few days, he progressively improved. Myelopathy is an important adverse effect of intrathecal methotrexate, which may cause clinical and imaging features resembling subacute combined degeneration of the spinal cord. CNS infiltration must be excluded, intrathecal chemotherapy stopped and deficiency of folate or vitamin B12 treated as appropriate. |
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| MeSH term(s) | Adult ; Humans ; Magnetic Resonance Imaging ; Male ; Methotrexate/adverse effects ; Precursor Cell Lymphoblastic Leukemia-Lymphoma/chemically induced ; Precursor Cell Lymphoblastic Leukemia-Lymphoma/drug therapy ; Spinal Cord Diseases/chemically induced ; Spinal Cord Diseases/diagnostic imaging ; Subacute Combined Degeneration/chemically induced ; Subacute Combined Degeneration/diagnostic imaging ; Young Adult | |||||
| Chemical Substances | Methotrexate (YL5FZ2Y5U1) | |||||
| Language | English | |||||
| Publishing date | 2021-10-29 | |||||
| Publishing country | England | |||||
| Document type | Case Reports ; Journal Article | |||||
| ZDB-ID | 2170881-2 | |||||
| ISSN | 1474-7766 ; 1474-7758 | |||||
| ISSN (online) | 1474-7766 | |||||
| ISSN | 1474-7758 | |||||
| DOI | 10.1136/practneurol-2021-003154 | |||||
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| Database | MEDical Literature Analysis and Retrieval System OnLINE |
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