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CC BY-NC-ND 4.0 · Avicenna J Med 2021; 11(03): 160-162
DOI: 10.1055/s-0041-1732486
Case Report

Cytotoxic Lesion in the Splenium of Corpus Callosum Secondary to Subacute Methotrexate Neurotoxicity

Ahmad A. Al-Awwad 
1   Department of Neurology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, United States
,
Ahmed Koriesh
2   Department of Neurology, University of Missouri, Columbia, Missouri, United States
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Abstract

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.

Keywords

methotrexate neurotoxicity - splenium lesion - dextromethorphan


Publikationsverlauf

Artikel online veröffentlicht:
04. August 2021

© 2021. Syrian American Medical Society. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

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  • References

  • 1 FDA methotrexate label. Available at: https://www.accessdata.fda.gov/drugsatfda_docs/label/2016/008085s066lbl.pdf. Accessed June 9, 2021
  • 2 Rollins N, Winick N, Bash R, Booth T. Acute methotrexate neurotoxicity: findings on diffusion-weighted imaging and correlation with clinical outcome. AJNR Am J Neuroradiol 2004; 25 (10) 1688-1695
    PubMedGoogle Scholar
  • 3 Ebner F, Ranner G, Slavc I. et al. MR findings in methotrexate-induced CNS abnormalities. AJNR Am J Neuroradiol 1989; 10 (05) 959-964
    PubMedGoogle Scholar
  • 4 Smith B. Brain damage after intrathecal methotrexate. J Neurol Neurosurg Psychiatry 1975; 38 (08) 810-815
    CrossrefPubMedGoogle Scholar
  • 5 Afshar M, Birnbaum D, Golden C. Review of dextromethorphan administration in 18 patients with subacute methotrexate central nervous system toxicity. Pediatr Neurol 2014; 50 (06) 625-629
    CrossrefPubMedGoogle Scholar
  • 6 Boogerd W, vd Sande JJ, Moffie D. Acute fever and delayed leukoencephalopathy following low dose intraventricular methotrexate. J Neurol Neurosurg Psychiatry 1988; 51 (10) 1277-1283
    CrossrefPubMedGoogle Scholar
  • 7 Chan ES, Cronstein BN. Molecular action of methotrexate in inflammatory diseases. Arthritis Res 2002; 4 (04) 266-273
    CrossrefPubMedGoogle Scholar
  • 8 Vezmar S, Becker A, Bode U, Jaehde U. Biochemical and clinical aspects of methotrexate neurotoxicity. Chemotherapy 2003; 49 (1-2) 92-104
    CrossrefPubMedGoogle Scholar
  • 9 Kishi S, Griener J, Cheng C. et al. Homocysteine, pharmacogenetics, and neurotoxicity in children with leukemia. J Clin Oncol 2003; 21 (16) 3084-3091
    CrossrefPubMedGoogle Scholar
  • 10 Drachtman RA, Cole PD, Golden CB. et al. Dextromethorphan is effective in the treatment of subacute methotrexate neurotoxicity. Pediatr Hematol Oncol 2002; 19 (05) 319-327
    CrossrefPubMedGoogle Scholar
  • 11 Fustino NJ, Juhl K, Leister J. Dextromethorphan administration on day 0 and day 7 for secondary prevention of methotrexate-induced neurotoxicity in childhood acute lymphoblastic leukemia: a retrospective case series. J Pediatr Hematol Oncol 2020; doi: DOI: 10.1097/MPH.0000000000001714.
    CrossrefPubMedGoogle Scholar
  • 12 von R Kummer, Dzialowski I. Imaging of cerebral ischemic edema and neuronal death. Neuroradiology 2017; 59 (06) 545-553
    CrossrefPubMedGoogle Scholar
  • 13 Starkey J, Kobayashi N, Numaguchi Y, Moritani T. Cytotoxic lesions of the corpus callosum that show restricted diffusion: mechanisms, causes, and manifestations. Radiographics 2017; 37 (02) 562-576
    CrossrefPubMedGoogle Scholar
  • 14 Goursaud S, Kozlova EN, Maloteaux JM, Hermans E. Cultured astrocytes derived from corpus callosum or cortical grey matter show distinct glutamate handling properties. J Neurochem 2009; 108 (06) 1442-1452
    CrossrefPubMedGoogle Scholar