Cytotoxic Lesion in the Splenium of Corpus Callosum Secondary to Subacute Methotrexate Neurotoxicity
Methotrexate neurotoxicity can present with a wide spectrum of neurologic symptoms and brain magnetic resonance imaging (MRI) typically demonstrates cerebral edema, demyelination, multifocal white matter necrosis, and atrophy relatively selective for the deep cerebral white matter. Here, we report a...
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Wolters Kluwer Medknow Publications
2021-07-01
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doaj-05a2552e088446b7a214d225a9305f9d2021-09-20T22:41:28ZengWolters Kluwer Medknow PublicationsAvicenna Journal of Medicine2231-07702249-44642021-07-01110316016210.1055/s-0041-1732486Cytotoxic Lesion in the Splenium of Corpus Callosum Secondary to Subacute Methotrexate NeurotoxicityAhmad A. Al-Awwad0Ahmed Koriesh1Department of Neurology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, United StatesDepartment of Neurology, University of Missouri, Columbia, Missouri, United StatesMethotrexate neurotoxicity can present with a wide spectrum of neurologic symptoms and brain magnetic resonance imaging (MRI) typically demonstrates cerebral edema, demyelination, multifocal white matter necrosis, and atrophy relatively selective for the deep cerebral white matter. Here, we report a case of subacute methotrexate neurotoxicity in a 40-year-old man with B cell acute lymphoblastic leukemia. Brain MRI showed cytotoxic lesion in the splenium of corpus callosum and left middle cerebellar peduncle. Patient significantly improved 24 hours after receiving oral dextromethorphan. Methotrexate neurotoxicity should be suspected in any symptomatic patient receiving high dose of methotrexate or intrathecal methotrexate therapy. Dextromethorphan should be considered in these patients as it can modulate the excitatory responses to homocysteine and its metabolite which are usually elevated in such patients.http://www.thieme-connect.de/DOI/DOI?10.1055/s-0041-1732486methotrexate neurotoxicitysplenium lesiondextromethorphan |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Ahmad A. Al-Awwad Ahmed Koriesh |
spellingShingle |
Ahmad A. Al-Awwad Ahmed Koriesh Cytotoxic Lesion in the Splenium of Corpus Callosum Secondary to Subacute Methotrexate Neurotoxicity Avicenna Journal of Medicine methotrexate neurotoxicity splenium lesion dextromethorphan |
author_facet |
Ahmad A. Al-Awwad Ahmed Koriesh |
author_sort |
Ahmad A. Al-Awwad |
title |
Cytotoxic Lesion in the Splenium of Corpus Callosum Secondary to Subacute Methotrexate Neurotoxicity |
title_short |
Cytotoxic Lesion in the Splenium of Corpus Callosum Secondary to Subacute Methotrexate Neurotoxicity |
title_full |
Cytotoxic Lesion in the Splenium of Corpus Callosum Secondary to Subacute Methotrexate Neurotoxicity |
title_fullStr |
Cytotoxic Lesion in the Splenium of Corpus Callosum Secondary to Subacute Methotrexate Neurotoxicity |
title_full_unstemmed |
Cytotoxic Lesion in the Splenium of Corpus Callosum Secondary to Subacute Methotrexate Neurotoxicity |
title_sort |
cytotoxic lesion in the splenium of corpus callosum secondary to subacute methotrexate neurotoxicity |
publisher |
Wolters Kluwer Medknow Publications |
series |
Avicenna Journal of Medicine |
issn |
2231-0770 2249-4464 |
publishDate |
2021-07-01 |
description |
Methotrexate neurotoxicity can present with a wide spectrum of neurologic symptoms and brain magnetic resonance imaging (MRI) typically demonstrates cerebral edema, demyelination, multifocal white matter necrosis, and atrophy relatively selective for the deep cerebral white matter. Here, we report a case of subacute methotrexate neurotoxicity in a 40-year-old man with B cell acute lymphoblastic leukemia. Brain MRI showed cytotoxic lesion in the splenium of corpus callosum and left middle cerebellar peduncle. Patient significantly improved 24 hours after receiving oral dextromethorphan. Methotrexate neurotoxicity should be suspected in any symptomatic patient receiving high dose of methotrexate or intrathecal methotrexate therapy. Dextromethorphan should be considered in these patients as it can modulate the excitatory responses to homocysteine and its metabolite which are usually elevated in such patients. |
topic |
methotrexate neurotoxicity splenium lesion dextromethorphan |
url |
http://www.thieme-connect.de/DOI/DOI?10.1055/s-0041-1732486 |
work_keys_str_mv |
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1717373859437477888 |