静脉滴注大剂量甲氨蝶呤致亚急性神经中毒  

Subacute neurotoxicity induced by high-dose intravenous methotrexate infusion

作　　者：王思平[1] 

机构地区：[1]杭州市第三人民医院药剂科,310009

出　　处：《药物不良反应杂志》2012年第2期116-117,共2页Adverse Drug Reactions Journal

摘　　要：1例20岁男性患者因骨肉瘤给予2个周期大剂量甲氨蝶呤化疗(8 g/m2)。第2次化疗后第7天,患者突然出现言语不畅、左手麻木、恶心、乏力,后逐渐进展为失语、双上肢强直、双下肢麻木。实验室检查:白细胞计数12.5×109/L,红细胞计数3.6×1012/L,血红蛋白111 g/L,血小板计数101×109/L。头部CT扫描未见异常。给予吸氧。约3 h后症状好转。第2天下午患者在无诱因情况下又出现相似症状。颅脑磁共振成像、弥散加权成像、脑电图、心脏多普勒超声、颈动脉超声检查均正常。静脉滴注马来酸桂哌齐特和胞磷胆碱,2 d后症状消失。A 20-year-old man with osteosarcoma received two cycles of chemotherapy treatment with high-dose methotrexate （8 g/m2 ）. On day 7 after the second cycle of chemotherapy, the patient suddenly experienced dysphasia, accompanied by numbness of left hand, nausea, asthenia, and gradually developed aphasia, stiffness in both upper limbs and numbness in both lower limbs. Laboratory tests showed the following values： WBC count 12.5 × 109/L, RBC count 3.6 × 1012/L, hemoglobin 111 g/L, and platelet count 101 × 109/L. A cranial CT scan revealed no abnormal findings. He was treated with oxygen inhalation. His condition improved after three hours. Similar symptoms recurred in the absence of other causative factors in the next afternoon. Brain magnetic resonance imaging, diffusion- weighted imaging, electroencephalogram, ultrasonic cardiogram and carotid ultrasound imaging showed normal findings. An IV infusion of cinepazide maleate and citicoline was given. Two days later, his symptoms disappeared.

关 键 词：甲氨蝶呤 神经病学表现 

分 类 号：R595.3[医药卫生—内科学]