Methotrexate leukoencephalopathy presenting as Klüver-Bucy syndrome and uncinate seizures.
Methotrexate causes several biochemical changes that impact the nervous system. The neurotoxicity usually affects the cerebral white matter, causing a leukoencephalopathy that can be chronic and progressive with cognitive decline. A 15-year-old male developed olfactory seizures and behavioral abnormalities (hypersexuality, placidity, and memory disturbances) compatible with partial Klüver-Bucy syndrome after treatment for central nervous system leukemia with intraventricular methotrexate. A magnetic resonance imaging study revealed evidence of white matter disease affecting both temporal lobes. A brain biopsy revealed a necrotizing encephalopathy compatible with methotrexate-related white matter injury. It may be prudent to verify normal cerebrospinal fluid dynamics before the administration of intraventricular methotrexate in children with a history of central nervous system leukemia.
Antunes
Nuno Lobo
NL
Department of Pediatrics, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA.
Souweidane
Mark M
MM
Lis
Eric
E
Rosenblum
Marc K
MK
Steinherz
Peter G
PG
D000293:Adolescent; D000964:Antimetabolites, Antineoplastic / Q000009:adverse effects*; D001921:Brain / Q000473:pathology; D003937:Diagnosis, Differential; D004791:Enzyme Inhibitors / Q000009:adverse effects; D004828:Epilepsies, Partial / Q000134:cerebrospinal fluid / Q000139:chemically induced*; D006801:Humans; D020232:Kluver-Bucy Syndrome / Q000134:cerebrospinal fluid / Q000139:chemically induced*; D007938:Leukemia / Q000134:cerebrospinal fluid / Q000188:drug therapy; D007968:Leukoencephalopathy, Progressive Multifocal / Q000134:cerebrospinal fluid / Q000139:chemically induced*; D008297:Male; D008727:Methotrexate / Q000009:adverse effects*
D000964:Antimetabolites, Antineoplastic; D004791:Enzyme Inhibitors; D008727:Methotrexate