Abstract
The differential diagnosis for demyelinating diseases can be quite vast. Although it is often equated with multiple sclerosis (MS) or one of its known variants, other causes such as infection, metabolic disorder, and ischemia should be considered. This differential includes the toxic-metabolic derangements in white matter seen in a group of patients receiving chemotherapeutics. These case presentations illustrate the clinical course of methotrexate toxicity and how the correspondent imaging can mimic demyelinating disease. Seizures and stroke-like presentation are much more commonly seen in MTX toxicity than in MS, and off-label treatment options are available. Clinical outcomes may vary but are often favorable.
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Shuper A, Stark B, Kornreich L, Cohen IJ, Avrahami G, Yaniv I. Methotrexate-related neurotoxicity in the treatment of childhood acute lymphoblastic leukemia. Isr Med Assoc J. 2002;4(11):1050–3.
Bhojwani D, Sabin ND, Pei D, Yang JJ, Khan RB, Panetta JC, et al. Methotrexate-induced neurotoxicity and leukoencephalopathy in childhood acute lymphoblastic leukemia. J Clin Oncol. 2014;32(9):949–59.
Mahoney DH, Shuster JJ, Nitschke R, Lauer SJ, Steuber CP, Winick N, Camitta B. Acute neurotoxicity in children with B-precursor acute lymphoid leukemia: an association between intermediate-dose intravenous methotrexate and intrathecal triple therapy: a Pediatric Oncology Group study. J Clin Oncol. 1998;16(5):1712–22.
Rubinstein LJ, Herman MM, Long TF, Wilbur JR. Disseminated necrotizing leukoencephalopathy: a complication of treated central nervous system leukemia and lymphoma. Cancer. 1975;35(2):291–305.
Kim JY, Kim ST, Nam DH, Lee JI, Park K, Kong DS. Leukoencephalopathy and disseminated necrotizing leukoencephalopathy following intracecal methotrexate chemotherapy and radiation therapy for central nerve system lymphoma or leukemia. J Korean Neurosurg Soc. 2011;50(4):304–10.
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):1688–95.
Sandoval C, Kutscher M, Jayabose S, Tenner M. Neurotoxicity of intrathecal methotrexate: MR imaging findings. AJNR Am J Neuroradiol. 2003;24(9):1887–90.
Rahiem Ahmed Y, Hasan Y. Prevention and management of high dose methotrexate toxicity. J Cancer Sci Ther. 2013;5(3):106–12.
Geiser CF, BIshop Y, Jaffe N, Furman L, Traggis D, Frei E. Adverse effects of intrathecal methotrexate in children with acute leukemia in remission. Blood. 1975;45(2):189–95.
Balachandran C, McCLuskey PJ, Champion GD, Halmagvi GM. Methotrexate induced optic neuropathy. Clin Exp Ophthalmol. 2002;30(6):440–1.
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Ramos Canseco, J., Bhise, V.V. (2017). Methotrexate Toxicity. In: Waubant, E., Lotze, T. (eds) Pediatric Demyelinating Diseases of the Central Nervous System and Their Mimics. Springer, Cham. https://doi.org/10.1007/978-3-319-61407-6_16
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DOI: https://doi.org/10.1007/978-3-319-61407-6_16
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