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Childs Nervous System

, Volume 6, Issue 4, pp 231–235 | Cite as

Transient focal leukoencephalopathy following intraventricular methotrexate and cytarabine

A complication of the Ommaya reservoir: case report and review of the literature
  • V. Colamaria
  • R. Caraballo
  • C. Borgna-Pignatti
  • P. Marradi
  • R. Balter
  • C. Mazza
  • C. Procacci
  • B. Dalla Bernardina
Article

Abstract

A 14-year-old boy, suffering from acute lymphoblastic leukemia with meningeal involvement, was treated with intraventricular methotrexate and cytosine arabinoside, administered via an Ommaya reservoir (OR). Three months later, right occipital headache, vomiting, and lethargy appeared. Cerebrospinal fluid specimens showed increased proteins and a right frontal slow-wave focus was evident on the EEG recording. The computed tomography scan revealed white matter hypodensity within the right frontal and rolandic regions. After injection of medium contrast, an abscesslike hyperdensity appeared, surrounding both a well-placed cannula tip and the right frontal horn of the lateral ventricle. Brain swelling and shift signs were also evident. Nine cases of focal methotrexate leukoencephalopathy have been previously reported, and in six of these there was a misplaced OR cannula tip. The focal meihotrexate leukoencephalopathy seems to be related to the neurotoxicity of the drugs administered, and may also exist with a well-placed OR cannula tip. Immediate removal of the catheter may be associated with a benign evolution.

Key words

Methotrexate leukoencephalopathy Ommaya reservoir Computed tomography Magnetic resonance imaging Meningeal leukemia 

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Copyright information

© Springer-Verlag 1990

Authors and Affiliations

  • V. Colamaria
    • 1
  • R. Caraballo
    • 2
  • C. Borgna-Pignatti
    • 1
  • P. Marradi
    • 1
  • R. Balter
    • 1
  • C. Mazza
    • 4
  • C. Procacci
    • 3
  • B. Dalla Bernardina
    • 2
  1. 1.Department of PediatricsVerona UniversityPoliclinico di Borgo Roma
  2. 2.Child Neuropsychiatry Verona UniversityPoliclinico di Borgo Roma
  3. 3.Institute of RadiologyVerona UniversityPoliclinico di Borgo Roma
  4. 4.Department of NeurosurgeryOspedale di Borgo TrentoVeronaItaly

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