Transtentorial herniation caused by an intracranial mass lesion following high-dose methotrexate.
A patient with intracranial osteosarcoma that arose 16 years after radiation therapy for hereditary retinoblastoma developed fatal cerebral edema and brainstem herniation after she received a single dose of intravenous methotrexate. Autopsy demonstrated extensive necrosis of the tumor mass, as well as necrotizing vascular damage within the neoplasm. Although high-dose methotrexate has been shown to be useful in the treatment of primary osteogenic sarcoma, the tumoricidal effects of therapy appear to have caused a fatal rise in intracranial pressure.
Villareal
B
B
Department of Pediatrics, UCLA Center for the Health Sciences 90024.
Baum
L G
LG
Vinters
H V
HV
Feig
S A
SA
D000293:Adolescent; D003131:Combined Modality Therapy; D004677:Encephalocele / Q000209:etiology*; D005134:Eye Neoplasms / Q000188:drug therapy / Q000532:radiotherapy* / Q000601:surgery; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous / Q000009:adverse effects; D007427:Intracranial Pressure; D008727:Methotrexate / Q000009:adverse effects*; D009336:Necrosis; D009378:Neoplasms, Multiple Primary; D009381:Neoplasms, Radiation-Induced / Q000150:complications* / Q000188:drug therapy; D009918:Orbital Neoplasms / Q000150:complications* / Q000188:drug therapy; D012516:Osteosarcoma / Q000150:complications* / Q000188:drug therapy; D012175:Retinoblastoma / Q000188:drug therapy / Q000532:radiotherapy* / Q000601:surgery
D008727:Methotrexate