• BMJ case reports · Apr 2016

    Case Reports

    Alternating hemiparesis and orolingual apraxia as manifestations of methotrexate neurotoxicity in a paediatric case of acute lymphoblastic leukaemia.

    • Siew Mei Yap, Peter MacEneaney, Clodagh Ryan, and Orna O'Toole.
    • Department of Neurology, Mercy University Hospital, Cork, Ireland.
    • BMJ Case Rep. 2016 Apr 25; 2016.

    AbstractA 15-year-old girl with a recent diagnosis of acute lymphoblastic leukaemia was admitted to hospital with pancytopaenia after having received high-dose intrathecal methotrexate 1 day prior. During the next week she had intermittent episodes of alternating hemiparesis associated with speech arrest lasting minutes to hours at a time. The episodes were not associated with altered level of consciousness or headache. MRI of the brain showed features consistent with methotrexate encephalopathy. This report discusses the typical clinical and radiological features of methotrexate neurotoxicity in addition to differential diagnoses and the proposed pathophysiological mechanisms.2016 BMJ Publishing Group Ltd.

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