Subacute Methotrexate Encephalopathy Mimicking Ischemic Stroke With Dynamic Changes on Magnetic Resonance Imaging

Yamanaka, Kei; Okata, Takuya; Sambongi, Yoshiki; Yamanaka, I; Tanimoto, Kazuki; Ago, Tetsuro; Kitazono, Takanari; Kitayama, Jiro

doi:10.1016/j.jstrokecerebrovasdis.2018.06.007

Cited by 6 publications

(4 citation statements)

References 6 publications

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“…Selected chemotherapeutic agents (viz. cisplatin, methotrexate, L-asparaginase) 255,256 and antiangiogenic agents (viz. paclitaxel, angiostatin) [257][258][259] have also been associated with cerebral stroke.…”

Section: Glioma Leads To Ischemic Stroke and Brain Injuriesmentioning

confidence: 99%

The interrelationship between cerebral ischemic stroke and glioma: a comprehensive study of recent reports

Ghosh

Chakraborty

Sarkar

et al. 2019

Sig Transduct Target Ther

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Glioma and cerebral ischemic stroke are two major events that lead to patient death worldwide. Although these conditions have different physiological incidences,~10% of ischemic stroke patients develop cerebral cancer, especially glioma, in the postischemic stages. Additionally, the high proliferation, venous thrombosis and hypercoagulability of the glioma mass increase the significant risk of thromboembolism, including ischemic stroke. Surprisingly, these events share several common pathways, viz. hypoxia, cerebral inflammation, angiogenesis, etc., but the proper mechanism behind this co-occurrence has yet to be discovered. The hypercoagulability and presence of the D-dimer level in stroke are different in cancer patients than in the noncancerous population. Other factors such as atherosclerosis and coagulopathy involved in the pathogenesis of stroke are partially responsible for cancer, and the reverse is also partially true. Based on clinical and neurosurgical experience, the neuronal structures and functions in the brain and spine are observed to change after a progressive attack of ischemia that leads to hypoxia and atrophy. The major population of cancer cells cannot survive in an adverse ischemic environment that excludes cancer stem cells (CSCs). Cancer cells in stroke patients have already metastasized, but early-stage cancer patients also suffer stroke for multiple reasons. Therefore, stroke is an early manifestation of cancer. Stroke and cancer share many factors that result in an increased risk of stroke in cancer patients, and vice-versa. The intricate mechanisms for stroke with and without cancer are different. This review summarizes the current clinical reports, pathophysiology, probable causes of co-occurrence, prognoses, and treatment possibilities.

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Section: Glioma Leads To Ischemic Stroke and Brain Injuriesmentioning

confidence: 99%

The interrelationship between cerebral ischemic stroke and glioma: a comprehensive study of recent reports

Ghosh

Chakraborty

Sarkar

et al. 2019

Sig Transduct Target Ther

View full text Add to dashboard Cite

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“…Abnormalities associated with MTX-induced encephalopathy reportedly first appear on DWI-MRI, being bilateral in most cases ( 12 , 15 , 16 ). However, we discovered that DWI-MRI may not capture abnormalities soon after the symptoms appear.…”

Section: Discussionmentioning

confidence: 99%

Methotrexate-induced Subacute Encephalopathy That Showed No Abnormalities on Magnetic Resonance Imaging Soon after Symptom Appearance

et al. 2023

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A 21-year-old woman was diagnosed with acute lymphoblastic leukemia. After the administration of intrathecal methotrexate (MTX), the patient experienced dysarthria and paralysis for one hour. Magnetic resonance imaging (MRI) performed one hour from the onset and just before symptoms disappeared revealed no abnormalities. The next day, the symptoms appeared again, and diffusion-weighed MRI revealed a highintensity area in the left frontal lobe. The patient was diagnosed with MTX-induced encephalopathy. This case suggested that MRI performed as soon as symptoms appear might show normal findings in MTXinduced encephalopathy.

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“…Methotrexate encephalopathy can present with stroke-like symptoms. But the rapid reversal of MR abnormalities in parallel with neurological symptoms contribute to its diagnosis [83,84]. Metronidazole Induced Encephalopathy (MIE) can also mimic stroke.…”

Section: Toxicity and Medication Side Effectsmentioning

confidence: 99%

Stroke mimics: A review

Wang

2023

J Clin Images Med Case Rep

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Subacute Methotrexate Encephalopathy Mimicking Ischemic Stroke With Dynamic Changes on Magnetic Resonance Imaging

Cited by 6 publications

References 6 publications

The interrelationship between cerebral ischemic stroke and glioma: a comprehensive study of recent reports

The interrelationship between cerebral ischemic stroke and glioma: a comprehensive study of recent reports

Methotrexate-induced Subacute Encephalopathy That Showed No Abnormalities on Magnetic Resonance Imaging Soon after Symptom Appearance

Stroke mimics: A review

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