Agarwal Amit, Vijay Kanupriya, Thamburaj Krishnamoorthy, Ouyang Tao
Department of Radiology, Penn State University, Hershey Medical Center, 500 University Drive, Hershey, PA 17036, USA.
Emerg Radiol. 2011 Aug;18(4):345-7. doi: 10.1007/s10140-010-0931-6. Epub 2011 Jan 18.
Methotrexate (MTX) is an indispensable antimetabolite for the treatment of oncological and immunological disorders in all age groups. It can be administrated intravenously as well as intrathecally and may be used alone or in combination with other drugs. Chronic leukoencephalopathy is a well-known side effect of MTX, especially in conjunction with intrathecal administration. However, acute neurotoxicity with confusion, disorientation, seizures, and focal deficits may also be seen. This can clinically mimic stroke with restricted diffusion on MRI. However, unlike stroke, there is resolution of clinical and imaging findings within 1-4 weeks. We report two cases of transient leukoencephalopathy following intrathecal methotrexate, with complete clinical and radiological resolutions on follow-up.
甲氨蝶呤（MTX）是治疗各年龄组肿瘤和免疫性疾病不可或缺的抗代谢药物。它可以静脉给药，也可以鞘内给药，可单独使用或与其他药物联合使用。慢性白质脑病是MTX众所周知的副作用，尤其是在鞘内给药时。然而，也可能出现伴有意识模糊、定向障碍、癫痫发作和局灶性神经功能缺损的急性神经毒性。这在临床上可能类似于MRI上扩散受限的中风。然而，与中风不同的是，临床和影像学表现会在1 - 4周内消退。我们报告了两例鞘内注射甲氨蝶呤后发生的短暂性白质脑病病例，随访时临床和影像学表现完全恢复。
