RT Journal Article
SR Electronic
T1 Myelopathy associated with intrathecal methotrexate
JF Practical Neurology
JO Pract Neurol
FD BMJ Publishing Group Ltd
SP practneurol-2021-003154
DO 10.1136/practneurol-2021-003154
A1 Pedro Gustavo Barros Rodrigues
A1 Talles Tavares de Lima
A1 Fernando Barroso Duarte
A1 Paulo Ribeiro Nóbrega
YR 2021
UL http://pn.bmj.com/content/early/2021/10/28/practneurol-2021-003154.abstract
AB A 21-year-old man developed progressive and bilateral lower limb numbness, gait impairment and urinary incontinence over 10 days. He had received intrathecal methotrexate 20 days previously for acute lymphoblastic B-cell leukaemia, following 7 months of systemic chemotherapy. MR scan of the spinal cord showed bilateral symmetric and extensive T2/fluid attenuated inversion recovery (FLAIR) increased signal involving the dorsal columns in the thoracic cord. His serum folate concentration was at the lower end of the normal range. We stopped the intrathecal chemotherapy and gave folate; after a few days, he progressively improved. Myelopathy is an important adverse effect of intrathecal methotrexate, which may cause clinical and imaging features resembling subacute combined degeneration of the spinal cord. CNS infiltration must be excluded, intrathecal chemotherapy stopped and deficiency of folate or vitamin B12 treated as appropriate.