Acute motor neuropathy after intrathecal treatment with methotrexate: A case report

Article type: Research Article

Authors: Pisani, Francesco | Scarano, Angela

Affiliations: Child Neuropsychiatric Unit, Department of Neuroscience, University of Parma, Italy

Note: [] Correspondence: Dr. Francesco Pisani, Department of Neuroscience, Via Gramsci, 14, 43100 Parma, Italy. Tel.: +39 0521 702750; Fax: +39 0521 290458; E-mail: [email protected]

Abstract: Intrathecal therapy with methotrexate and cytosine-arabinoside is a therapeutic strategy for maintaining remission in patients with acute lymphoblastic leukemia, that is associated with neurological side effects are described. We report a 4-year-old girl who became tetraplegic after the last dose of intrathecal therapy. Cerebrospinal fluid showed elevated protein level and nerve conduction study revealed a motor neuronopathy. Spine magnetic resonance imaging revealed gadolinium enhancement of the anterior roots of the cauda equina. We describe a myelopathy confined to the anterior horns and anterior spinal nerve roots without sensory involvement caused by intrathecal methotrexate. The pathogenesis of this selective involvement remains uncertain.

Keywords: Intrathecal methotrexate, acute lymphocytic leukemia, motor neuronopathy, ventral polyradiculopathy

Journal: Journal of Pediatric Neurology, vol. 5, no. 3, pp. 247-249, 2007