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.
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Bjorgen JE, Gold LHA (1977) Computed tomographic appearance of methotrexate-induced necrotizing leukoencephalopathy. Radiology 122:377–378
Bleyer WA (1988) Central nervous system leukemia. Pediatr Clin North Am 35:789–814
Bleyer WA, Griffin TW (1980) White matter necrosis; mineralizing microangiopathy, and intellectual abilities in survivors of childhood leukemia: associations with central nervous system irradiation and methotrexate therapy. In: Gilbert HA, Kagan AR (eds) Radiation damage to the nervous system. Raven Press, New York, pp 155–174
Bleyer WA, Pizzo PA, Spence AM, Platt WD, Benjamin DR, Kolins J, Poplack DG (1978) The Ommaya reservoir. Newly recognized complications and recommendations for insertion and use. Cancer 41:2431–2437
Callaghan JT, Ausman JI, Clubb R (1981) CSF perfusion to treat intraventricular penicillin toxicity. Arch Neurol 38: 390–391
Diamond RD, Bennett JE (1973) A subcutaneous reservoir for intrathecal therapy of fungal meningitis. N Engl J Med 288:186–188
Duffner PK, Cohen ME, Brecher ML, Berger P, Parthasarathy KL, Bakshi S, Ettinger LJ, Freeman A (1984) CT abnormalities and altered methotrexate clearance in children with CNS leukemia. Neurology (Cleveland) 34:229–233
Kay HEM, Knapton PJ, O'Sullivan JP, Wells DG, Harris RF, Innes EM, Stuart J, Schwartz FCM, Thompson EN (1972) Encephalopathy in acute leukaemia associated with methotrexate therapy. Arch Dis Child 47:344–354
Obbens EAMT, Leavens ME, Beal JW, Lee YY (1985) Ommaya reservoirs in 387 cancer patients: a 15-year experience. Neurology 35:1274–1278
Ommaya AK, Oxon MA, Punjab MB (1963) Subcutaneous reservoir and pump for sterile access to ventricular cerebrospinal fluid. Lancet 11:983–984
Packer RJ, Zimmerman RA, Rosenstock J, Rorke LB, Norris DG, Berman PH (1981) Focal encephalopathy following methotrexate therapy administration via a misplaced intraventricular catheter. Arch Neurol 38:450–452
Peylan-Ramu N, Poplack DG, Blei CL, Herdt JR, Vermess M, Di Chiro G (1977) Computer assisted tomography in methotrexate encephal opathy. J Comput Assist Tomogr 1:216–221
Poskitt KJ, Steinbok P, Flodmark O (1988) Methotrexate leukoencephalopathy mimicking cerebral abscess on CT brain scan. Child's Nerv Syst 4:119–121
Price RA, Jamieson PA (1975) The central nervous system in childhood leukemia. 11. Subacute leukoencephalopathy. Cancer 35:306–318
Rubin RC, Ommaya AK, Henderson ES, Bering EA, Rall DP (1966) Cerebrospinal fluid perfusion for central nervous system neoplasm. Neurology (Minneap) 16:680–692
Rubinstein LJ, Herman MM, Long TF, Wilbur JR (1975) Disseminated necrotizing leukoencephalopathy: a complication of treated central nervous system leukemia and lymphoma. Cancer 35:291–305
Shapiro WR, Chernik NL, Posner JB (1973) Necrotizing encephalopathy following intraventricular instillation of methotrexate. Arch Neurol 28:96–102
Spiers ASD, Booth AE (1973) Reservoirs for intraventricular chemotherapy. Lancet 1:1263
Wendling LR, Bleyer WA, DiChiro G, McIlvanie SK (1978) Transient, severe periventricular hypodensity after leukemic prophylaxis with cranial irradiation and intrathecal methotrexate. J Comput Assist Tomogr 2:502–505
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Colamaria, V., Caraballo, R., Borgna-Pignatti, C. et al. Transient focal leukoencephalopathy following intraventricular methotrexate and cytarabine. Child's Nerv Syst 6, 231–235 (1990). https://doi.org/10.1007/BF01850981
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DOI: https://doi.org/10.1007/BF01850981