A Stroke Mimic: Methotrexate-induced Neurotoxicity in the Emergency Department

Methotrexate Associated Toxicity: An Alarming Benign Entity

“…The neurotoxicity is one of the side effects associated to the MTX usage and it can change according to the dosage, route and frequency of administration. The factors that increase the incidence risk are: High dosage, intrathecal administration and young age [2,3].…”

“…The probably responsible mechanisms for the neurotoxicity aren't clear yet but they are thought being multi-factorial [2]. According to the literature, there could be and alteration of the folate homeostasis in the CNS and/or a direct neuronal lesion [1].…”

“…The following condition happens: The inhibition of the hydrofolate reductasis, caused by the MTX, affect the increment of the homocystein levels in the blood and in the liquor that consequently increase the homocystein levels. This way, not only this substance actuates as direct vascular toxic for the endothelium, but also its metabolism will actuate as agonist of the NMDAR, probably resulting from this condition the neurological findings associated to the neurotoxicity [1][2][3]. Moreover, a secondary neurological lesion could occur such as the adenosine releasing from the endothelial cells and fibroblasts [3].…”

“…The acute lymphoblastic lymphoma (ALL) is the most common form of leukemia in children, being its treatment one of the leading causes of death associated to cancer [1,2].…”

“…However, as with any drug, its usage is associated with some side effects: Neurological toxicity, skin toxicity, renal toxicity, hematological toxicity and hepatic toxicity. The neurological toxicity prevalence ranges between 2.3% and 15% and it can be characterized either by an acute or prolonged picture [2,3].…”