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Methotrexate-induced toxic leukoencephalopathy: an uncommon stroke mimic

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References

  1. Vazquez E, Lucaya J, Castellote A, Piqueras J, Sainz P, Olive T, Sanchez-Toledo J, Ortega JJ (2002) Neuroimaging in pediatric leukemia and lymphoma: differential diagnosis. Radiographics 22(6):1411–1428. https://doi.org/10.1148/rg.226025029

    Article  PubMed  Google Scholar 

  2. Baehring JM, Fulbright RK (2008) Delayed leukoencephalopathy with stroke-like presentation in chemotherapy recipients. J Neurol Neurosurg Psychiatry 79(5):535–539. https://doi.org/10.1136/jnnp.2007.123737

    Article  CAS  PubMed  Google Scholar 

  3. Quinn CT, Griener JC, Bottiglieri T, Hyland K, Farrow A, Kamen BA (1997) Elevation of homocysteine and excitatory amino acid neurotransmitters in the CSF of children who receive methotrexate for the treatment of cancer. J Clin Oncol 15(8):2800–2806. https://doi.org/10.1200/JCO.1997.15.8.2800

    Article  CAS  PubMed  Google Scholar 

  4. Quinn CT, Griener JC, Bottiglieri T, Arning E, Winick NJ (2004) Effects of intraventricular methotrexate on folate, adenosine, and homocysteine metabolism in cerebrospinal fluid. J Pediatr Hematol Oncol 26(6):386–388

    Article  PubMed  Google Scholar 

  5. Bernini JC, Fort DW, Griener JC, Kane BJ, Chappell WB, Kamen BA (1995) Aminophylline for methotrexate-induced neurotoxicity. Lancet 345(8949):544–547

    Article  CAS  PubMed  Google Scholar 

  6. Tsujimoto S, Yanagimachi M, Tanoshima R, Urayama KY, Tanaka F, Aida N, Goto H, Ito S (2016) Influence of ADORA2A gene polymorphism on leukoencephalopathy risk in MTX-treated pediatric patients affected by hematological malignancies. Pediatr Blood Cancer 63(11):1983–1989. https://doi.org/10.1002/pbc.26090

    Article  CAS  PubMed  Google Scholar 

  7. Bhojwani D, Sabin ND, Pei D, Yang JJ, Khan RB, Panetta JC, Krull KR, Inaba H, Rubnitz JE, Metzger ML, Howard SC, Ribeiro RC, Cheng C, Reddick WE, Jeha S, Sandlund JT, Evans WE, Pui CH, Relling MV (2014) Methotrexate-induced neurotoxicity and leukoencephalopathy in childhood acute lymphoblastic leukemia. J Clin Oncol 32(9):949–959. https://doi.org/10.1200/JCO.2013.53.0808

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Abrey LE, Yahalom J, DeAngelis LM (2000) Treatment for primary CNS lymphoma: the next step. J Clin Oncol 18(17):3144–3150. https://doi.org/10.1200/JCO.2000.18.17.3144

    Article  CAS  PubMed  Google Scholar 

  9. Thiel E, Korfel A, Martus P, Kanz L, Griesinger F, Rauch M, Roth A, Hertenstein B, von Toll T, Hundsberger T, Mergenthaler HG, Leithauser M, Birnbaum T, Fischer L, Jahnke K, Herrlinger U, Plasswilm L, Nagele T, Pietsch T, Bamberg M, Weller M (2010) High-dose methotrexate with or without whole brain radiotherapy for primary CNS lymphoma (G-PCNSL-SG-1): a phase 3, randomised, non-inferiority trial. Lancet Oncol 11(11):1036–1047. https://doi.org/10.1016/S1470-2045(10)70229-1

    Article  CAS  PubMed  Google Scholar 

  10. Watanabe K, Arakawa Y, Oguma E, Uehara T, Yanagi M, Oyama C, Ikeda Y, Sasaki K, Isobe K, Mori M, Hanada R, Koh K (2018) Characteristics of methotrexate-induced stroke-like neurotoxicity. Int J Hematol 108(6):630–636. https://doi.org/10.1007/s12185-018-2525-0

    Article  CAS  PubMed  Google Scholar 

  11. Agarwal A, Vijay K, Thamburaj K, Ouyang T (2011) Transient leukoencephalopathy after intrathecal methotrexate mimicking stroke. Emerg Radiol 18(4):345–347. https://doi.org/10.1007/s10140-010-0931-6

    Article  PubMed  Google Scholar 

  12. Yang J, Kim GS, Park HM (2015) A unique radiological case of intrathecal methotrexate-induced toxic leukoencephalopathy. J Neurol Sci 353(1–2):169–171. https://doi.org/10.1016/j.jns.2015.04.001

    Article  PubMed  Google Scholar 

  13. Iwatani K, Fujii N, Deguchi S, Tanimoto M (2012) Subacute methotrexate-related leukoencephalopathy with stroke-like presentation. Int J Hematol 96(6):683–684. https://doi.org/10.1007/s12185-012-1194-7

    Article  PubMed  Google Scholar 

  14. Cruz-Carreras MT, Chaftari P, Shamsnia A, Guha-Thakurta N, Gonzalez C (2017) Methotrexate-induced leukoencephalopathy presenting as stroke in the emergency department. Clin Case Rep 5(10):1644–1648. https://doi.org/10.1002/ccr3.1110

    Article  PubMed  PubMed Central  Google Scholar 

  15. Drachtman RA, Cole PD, Golden CB, James SJ, Melnyk S, Aisner J, Kamen BA (2002) Dextromethorphan is effective in the treatment of subacute methotrexate neurotoxicity. Pediatr Hematol Oncol 19(5):319–327. https://doi.org/10.1080/08880010290057336

    Article  CAS  PubMed  Google Scholar 

  16. Rogers P, Pan WJ, Drachtman RA, Haines C (2017) A stroke mimic: methotrexate-induced neurotoxicity in the emergency department. J Emerg Med 52(4):559–561. https://doi.org/10.1016/j.jemermed.2016.11.016

    Article  PubMed  Google Scholar 

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Correspondence to Roderick P. P. W. M. Maas.

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Roderick Maas, Sjoert Pegge, Dorothea Evers, and Anusha van Samkar report no disclosures.

Karin Klijn is supported by a clinical established investigator grant from the Dutch Heart Foundation (2012T077) and an Aspasia grant from ZonMw.

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This article does not contain any studies with human participants performed by any of the authors.

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Maas, R.P.P.W.M., Pegge, S.A.H., Evers, D. et al. Methotrexate-induced toxic leukoencephalopathy: an uncommon stroke mimic. Neurol Sci 40, 1307–1309 (2019). https://doi.org/10.1007/s10072-019-3711-4

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