Resumen de Intrathecal methotrexate-induced stroke-like syndrome in a pediatric patient with acute lymphoblastic leukemia

Sarah Kator, Mohammad A. Rattu, Kendra Yum, Sara S. Kim

• Purpose: Intrathecal (IT) methotrexate is primarily indicated for the treatment or prophylaxis of Central Nervous System (CNS) disease associated with hematologic and solid tumours. Although rare, IT methotrexate has been reported to be associated with neurotoxicity via various postulated mechanisms; however, no established treatment exists to manage this toxicity.

  Case report: We present a case of a 15-year-old female with Acute Lymphoblastic Leukemia (ALL) who developed a stroke-like syndrome following her fifth dose of IT methotrexate. The patient was treated with IV administration of leucovorin, aminophylline, and dexamethasone, and had resolution of her neurologic symptoms within two weeks of the treatment. While there is no established treatment for methotrexate-induced neurotoxicity, agents that have been studied include leucovorin, aminophylline, dextromethorphan, and steroids.

  Conclusion: Leucovorin, in combination with aminophylline and dexamethasone, contributed to resolution of IT-methotrexate-induced subacute neurological toxicities in our patient