Rogers Patrick, Pan Wilbur J, Drachtman Richard A, Haines Christopher
Department of Emergency Medicine, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey.
Department of Pediatric Hematology Oncology, Rutgers Cancer Institute of New Jersey, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey.
J Emerg Med. 2017 Apr;52(4):559-561. doi: 10.1016/j.jemermed.2016.11.016. Epub 2017 Jan 13.
Acute lymphoblastic leukemia (ALL) is the most common form of childhood leukemia. The treatment of ALL involves multimodality therapy, and methotrexate (MTX) remains a mainstay of treatment. A complication of MTX therapy includes acute, subacute, and chronic neurotoxocity. Signs and symptoms may range from headaches, dizziness, and mood disorders to seizures and stroke-like symptoms.
An 18-year-old woman with a history of ALL presented to the emergency department with acute onset of right-sided facial paralysis, right upper extremity flaccid paralysis, and right lower extremity weakness after receiving MTX therapy 3 days earlier. Diagnostic studies were unremarkable and the patient was treated with oral dextromethorphan for presumed MTX-induced neurotoxicity. The patient's symptoms began to improve within hours and she was discharged home within 48 hours with no neurologic deficits. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Emergency physicians should be aware of this complication of MTX therapy given the sensitivity in regards to time with respect to cerebral vascular accidents. An awareness of this complication in the setting of the appropriate history and physical examination can lead to an accurate diagnosis and intervention and the avoidance of administering thrombolytics.
急性淋巴细胞白血病（ALL）是儿童白血病最常见的形式。ALL的治疗涉及多模式疗法，甲氨蝶呤（MTX）仍然是治疗的主要手段。MTX治疗的并发症包括急性、亚急性和慢性神经毒性。体征和症状范围可能从头痛、头晕、情绪障碍到癫痫发作和类似中风的症状。
一名有ALL病史的18岁女性，在3天前接受MTX治疗后，因急性右侧面瘫、右上臂弛缓性麻痹和右下肢无力就诊于急诊科。诊断检查无异常，患者因推测为MTX诱导的神经毒性而接受口服右美沙芬治疗。患者症状在数小时内开始改善，48小时内出院，无神经功能缺损。急诊医生为何应了解此情况？：鉴于与脑血管意外相关的时间敏感性，急诊医生应了解MTX治疗的这一并发症。在有适当病史和体格检查的情况下意识到这一并发症可导致准确诊断和干预，并避免使用溶栓药物。
