METHOTREXATE NEUROTOXICITY IN A PATIENT WITH CEREBRAL ARTERITIS

We report the case of an 18 year-old woman treated for femoral osteoge nic sarcoma who presented generalized seizures requiring sedation, tra cheal intubation and artificial ventilation. CT brain scan showed diff use hypodensities. Doppler studies showed an increased cerebral arteri al resistance. Regional cerebral blood flow was decreased. A right car otid angiogram showed abnormalities consistent with diffuse cerebral a rteritis. The patient slowly recovered and 6 weeks later, magnetic res onance imaging showed disseminated areas of hyposignal on T1 and hyper signal on T2 weighted images. We reviewed the different published case s of acute high dose methotrexate neurotoxicity and the different unde rlying mechanisms.