Neurotoxicity Associated with Methotrexate: An Alarming Benign Entity

Introduction: Methotrexate is an essential drug in the treatment of children with acute lymphoblastic leukemia diseases. In this population, neurotoxicity has a prevalence range between 2.3-15% and can be characterized by a broad range of signs and symptoms (from headache to stroke-like symptoms).

Case Report: We present a young girl (11-year-old) with lymphoblastic lymphoma (in phase IIA) who as a history of leukoencephalopathy, which mimicked stroke (a transient episode of mild right central facial paresis, right hemiparesis with flexion of the finger and ataxia) one week after treatment with high doses intravenous methotrexate. Brain magnetic resonance imaging revealed "probable hyperacute ischemic lesion in the territory of perforating arteries of the left middle cerebral artery"; cervical eco-doppler and Bubber test were normal; thrombophilia study at the beginning of treatment of oncologic was normal. The patient`s symptoms completely improve within two days without sequels and was medicated with antiplatelet agent. Ten days after a new administration of methotrexate, she presented with right-side hemiparesis and dysarthria. Again with full resolution. The patient was discharged home without neurological symptoms and continued to the maintenance phase under prophylaxis with destometrophan (20 mg, 3 times daily) without intercurrences.

Conclusions: Neurotoxicity associated with methotrexate is transient and most patients continue to receive this therapy without intercurrences. Symptoms can be treated previously by administration of destometrophan and it is important that healthcare professionals recognize this entity.