Acute lumbar polyradiculoneuropathy as early sign of methotrexate intrathecal neurotoxicity: Case report and literature review

Montejo, Carmen; Navarro‐Otano, Judith; Mayà, Gerard; Campolo, Michela; Casanova‐Mollá, Jordi

doi:10.1002/ccr3.2026

Cited by 10 publications

(7 citation statements)

References 29 publications

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“…Other studies are designed for the adult population. Literature concerning clinico-radiologic findings in children with PRES often describe small series: 7 patients [11], 5 patients [14], 19 patients [15], and 8 patients [16]. Nevertheless, the number of patients in this study limits the statistical analysis.…”

Section: Study Limitationsmentioning

confidence: 89%

“…In total, 85.7% of patients were treated with intrathecal methotrexate, 76.2% of patients with corticosteroids, and 71.4% of patients with L-asparaginase. Intrathecal methotrexate is known for its neurotoxicity, and case reports with acute polyradiculoneuropathy [15], acute myelopathy [16] or MTX-induced stroke-like neurotoxicity [17] after intrathecal methotrexate administration have been published. Recent studies with animal models indicate possible late cognitive deficits induced by methotrexate [18,19].…”

Section: Pathophysiology Of Pres In Children With Malignancy or Bone Marrow Failurementioning

confidence: 99%

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Prognostic factors and seizure outcome in posterior reversible encephalopathy syndrome (PRES) in children with hematological malignancies and bone marrow failure: A retrospective monocentric study

Danhofer

Tomečková

Cerna

et al. 2019

Seizure

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The aim of this study was to evaluate seizure outcome in children with hematological malignancies and PRES and to identify prognostic factors that could help manage the syndrome. Method: We retrospectively reviewed the report data of 21 patients diagnosed with hematological malignancy or aplastic anemia and PRES between 2008 and 2018. Basic demographic data, oncology treatment, presymptomatic hypertension before PRES manifestation, neurological status, seizure type, and EEG and MRI findings at PRES onset and at the one-year follow-up visit were studied. Patients who developed remote symptomatic seizures or epilepsy were identified. Results: We included 21 children (11 females and 10 males) in the study. Sixteen patients (76.2%) were diagnosed with ALL and the rest individually with AML, CML, T-lymphoma, Burkitt lymphoma, and severe aplastic anemia. Presymptomatic hypertension (PSH) was evaluated in 19 patients and was present in 18 (94.7%). The duration was 9 h and more in 16 patients (88.8%); the severity was grade II in 12 patients (66.7%). Seizures as the initial symptom of PRES were present in 17 patients (80.9%). Four patients (19.0%) were assessed with remote symptomatic seizures. Two of them (9.5%) had ongoing seizures at the one-year follow-up visit and were diagnosed with epilepsy. The presence of gliosis on follow-up MRI indicated worse outcome with development of epilepsy (without statistical significance). Conclusions: PRES syndrome has an overall good prognosis and the evolution to epilepsy is rare. The severity and duration of PSH or seizure severity and EEG findings at PRES onsetwere not associated with worse neurological outcomes in this study.

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Section: Study Limitationsmentioning

confidence: 89%

Section: Pathophysiology Of Pres In Children With Malignancy or Bone Marrow Failurementioning

confidence: 99%

Prognostic factors and seizure outcome in posterior reversible encephalopathy syndrome (PRES) in children with hematological malignancies and bone marrow failure: A retrospective monocentric study

Danhofer

Tomečková

Cerna

et al. 2019

Seizure

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“…Chemotherapy-induced neurological syndromes encompass encephalopathy, seizures, arachnoiditis, cranial neuropathies, caudal equina syndrome, and peripheral neuropathy. 1 We herein describe a young girl with lymphoma who developed acute myelitis following intrathecal chemotherapy.…”

Section: Figmentioning

confidence: 99%

Acute Thoracolumbar Myelitis Secondary To Intrathecal Chemotherapy

Cheong

Tan

et al. 2021

JNRP

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“…In this case, proximal motor roots can be unexpectedly block with a variable extension of myelitis at the level of lumbar infusion producing a complete paresis in lower limbs (paraparesis) with a lower abdomen level of sensory loss together with urinary dysfunction. This is a devastating situation that has been reported in few cases with poor prognosis for recovery [16,17].…”

Section: Targets Of Neurotoxicity At Peripheral Nervesmentioning

confidence: 99%

Chemotherapy-Induced Peripheral Neuropathy: Mechanisms and Clinical Assessment

Casanova‐Mollá¹

2022

Neurotoxicity - New Advances

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Antineoplastic drugs may be neurotoxic and the clinical features frequently include distal sensory loss and neuropathic pain. This is related to a direct damage in sensory neurons and non-selective degeneration of sensory nerve fibers. Due to different mechanisms, there are agents that affects also motor or autonomic nerves. In the case of immune checkpoint inhibitors, an inflammatory response attacks the muscle, motor neurons or neuromuscular transmission. We present an easy-to-read article to understand first symptoms of chemotherapy-induced neuropathy (CIN) with describing each agent and the course of neuropathy as well as the clinical assessment with neurophysiological techniques. In addition, skin biopsy allows us to examine histological changes such as reinnervation. Neuroprotection with antioxidant therapy is possible but more effort in this field is needed.

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Acute lumbar polyradiculoneuropathy as early sign of methotrexate intrathecal neurotoxicity: Case report and literature review

Cited by 10 publications

References 29 publications

Prognostic factors and seizure outcome in posterior reversible encephalopathy syndrome (PRES) in children with hematological malignancies and bone marrow failure: A retrospective monocentric study

Prognostic factors and seizure outcome in posterior reversible encephalopathy syndrome (PRES) in children with hematological malignancies and bone marrow failure: A retrospective monocentric study

Acute Thoracolumbar Myelitis Secondary To Intrathecal Chemotherapy

Chemotherapy-Induced Peripheral Neuropathy: Mechanisms and Clinical Assessment

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