Introduction- Aims / Objectives of the study: Patients with childhood cancers may suffer from neurological complications owing to the primary disease and treatments. Methotrexate (MTX) induced central nervous system toxicity may result from both intratechal and intravenous administrations, and has specific radiologic findings. Methods: We report a 14-year-old adolescent girl with osteoblastic osteosarcoma and recurring neurological symptoms. Results: The patient was diagnosed with osteoblastic osteosarcoma in the left leg at 14 years of age. She currently received chemotherapy regimen with MTX. She had speech impairment and right arm paresis after she received trombocyte infusion for trombocytopenia the day before admission. Inital brain magnetic resonance imaging (MRI) showed bilaterally restricted diffusion in the centrum semiovale compatible with MTX toxicity. By the time she was admitted to our hospital, her symptoms had resolved. Neurological examination showed bilateral brisk deep tendon reflexes and left leg weakness due to prior surgery. Repeat brain MRI was normal. A few hours later she developed motor aphasia and right hemiparesis sparing awareness. Brain MRI findings showed restricted diffusion in the centrum semiovale. Leucovorin and methyl prednisolone was administered with complete resolution of neurologic symptoms and signs. Conclusion: Patients receiving MTX may present with stroke-like episodes, and prompt diagnosis may enable specific treatment based on certain etiology. Assessment of children with neurological problems should include a thorough evalution of systemic problems.

Gulsen ERSOZ
Hacettepe University
Turkey

Hilal Sen
Hacettepe University
Turkey

Rahsan Gocmen
Hacettepe University
Turkey

Guzide Burca Aydin
Hacettepe University
Turkey

Dilek Yalnizoglu
Hacettepe University
Turkey