RESUMO
Diffuse leukoencephalopathy is a well-known complication of methotrexate in intrathecal or high dose intravenous administration, especially when it is combined with cranial radiation therapy. However, low dose intravenous methotrexate induced leukoencephalopathy has not been reported previously. A 46-year-old female was administered intravenous methotrexate and 5-fluorouracil with oral cyclophosphamide after a modified radical mastectomy for breast cancer. After six cycles of chemotherapy, she developed rapidly progressing dementia and upper motor neuron signs. Brain MRI showed bilaterally symmetric white matter lesion without gadolinium enhancement. Laboratory investiga-tion showed no evidence of brain metastasis. This case suggests that low dose intravenous methotrexate can induce dif-fuse leukoencephalopathy.
Assuntos
Feminino , Humanos , Pessoa de Meia-Idade , Administração Intravenosa , Encéfalo , Neoplasias da Mama , Ciclofosfamida , Demência , Tratamento Farmacológico , Fluoruracila , Gadolínio , Leucoencefalopatias , Imageamento por Ressonância Magnética , Mastectomia Radical Modificada , Metotrexato , Neurônios Motores , Metástase NeoplásicaRESUMO
Iron deficiency anemia has been rarely reported as a cause of cerebral venous thrombosis but its pathogenic relationship with cerebral venous thrombosis is still unknown. A previously healthy 25-year old woman presented with headache, nausea, vomiting, and slight confusion. A magnetic resonance imaging and venogram revealed an infarction involving the right frontal subcortical white matter and left thalamus, with thrombosis in the internal cerebral vein, the vein of Galen. Etiological investigations for cerebral venous thrombosis disclosed no precipitating factors other than iron deficiency anemia. The patient's symptoms rapidly improved with anticoagulation and no neurologic deficits remained. We report a rare case of deep cerebral vein thrombosis associated with iron deficiency anemia without reactive thrombocytosis.
Assuntos
Adulto , Feminino , Humanos , Anemia Ferropriva , Veias Cerebrais , Cefaleia , Infarto , Ferro , Imageamento por Ressonância Magnética , Náusea , Manifestações Neurológicas , Fatores Desencadeantes , Tálamo , Trombocitose , Trombose , Trombose Venosa , VômitoRESUMO
BACKGROUND AND SIGNIFICANCE: Frontotemporal dementia is a behavioral disorder arising from nonAlzheimer's disease atrophy of frontal and anterior temporal lobe. Clinical manifestations include frontal lobe dysfunction. Kluver-Bucy syndrome or progressive language impairments. Two types of histological change underline, the atrophy. The commoner pathology is nerve cell loss and spongiform change with astrocytic gliosis. The second one is typical Pick-type histology characterized by intraneuronal inclusion body and astrocytic gliosis. We report a case with biopsy proved Pick's disease presenting with progressive nonfluent speech. CASE: A 41-years, old right-handed woman developed progressive language impairment over a period of 6 months. Brain MRI revealed asymmetric frontotemporal cortical atrophy more severe on the left side and 18F-FDG-brain, PET showed hypometabolism in the same area. Neuropsychological test including Korean version-Western Aphasia Battery revealed non-fluent speech as well as frontal lobe, dysfunction. A biopsy from left frontal lobe, demonstrate neuronal loss and diffuse astrogliosis. In the cytoplasm of remaining neurons are eosinophilic inclusion bodies which are neurofilament-positive with immunostaining. Senile plaque, neurofibrillary tangle and cortical Lewy body were absent. COMMENT: We report a case presenting with progressive nonfluent speech whose imaging and pathological findings are compatible with Pick's disease, which may be the first biopsy proven case in Korea.