Stroke-Like Hemiparesis During Acute Lymphoblastic Leukemia Treatment

İnci Yaman Bajin; Barış Kuşkonmaz; Şule Ünal; Selin Aytaç; Mualla Çetin; Selin Ardalı; Kader Karlı Oğuz; Fatma Gümrük

doi:10.32552/2020.ActaMedica.405

İnci Yaman Bajin Hacettepe University
Barış Kuşkonmaz Hacettepe University, Deparment of Pediatrics, Division of Pediatric Hematology 06100 Ankara/ Turkey
Şule Ünal Hacettepe University, Deparment of Pediatrics, Division of Pediatric Hematology 06100 Ankara/ Turkey
Selin Aytaç Hacettepe University, Deparment of Pediatrics, Division of Pediatric Hematology 06100 Ankara/ Turkey
Mualla Çetin Hacettepe University, Deparment of Pediatrics, Division of Pediatric Hematology 06100 Ankara/ Turkey
Selin Ardalı Hacettepe University, Deparment of Radiology, 06100 Ankara/ Turkey
Kader Karlı Oğuz Hacettepe University, Department of Radiology 06100 Ankara/ Turkey
Fatma Gümrük Hacettepe University, Deparment of Pediatrics, Division of Pediatric Hematology 06100 Ankara/ Turkey

DOI: https://doi.org/10.32552/2020.ActaMedica.405

Keywords: methotrexate, acute lymphoblastic leukemia, encephalopathy

Abstract

In this case report; a 12-year-old male with ALL who developed transient left hemiparesis associated with dysphasia and central facial paralysis 14 days after high dose methotrexate (5g/m²) and intrathecal MTX (12 mg, according to age) treatment has been reported. Cranial magnetic resonance imaging (MRI) revealed restricted diffusion in bilateral centrum semiovale compatible with MTX-induced acute encephalopathy. All clinical symptoms resolved completely without any treatment.

Clinical findings including headache, nausea, emesis, lethargy, altered mental status, blurred vision, aphasia, dysphasia, hemiparesis and cranial MRI findings of restricted diffusion that does not comply with the territory of any artery seizure should alert the physician for MTX-induced acute encephalopathy.

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