Regression Of Chronic Posterior Leukoencephalopathy After Stop Of Methotrexate Treatment
Marcon, G., Giovagnoli, A. R., Mangiapane, P., Erbetta, A., Tagliavini, F., & Girotti, F. (2009). Regression of chronic posterior leukoencephalopathy after stop of methotrexate treatment. Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology, 30(5), 375–378. https://doi.org/10.1007/s10072-009-0119-6
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Disease Location
Bilateral white matter of the occipital, parietal, and frontal lobes, pons, and thalamus
Personal Characteristics
59 -year-old male, right handed with essential hypertension
Clinical Characteristics
Posterior reversible leukoencephalopathy (prle) treated for psoriasis spondylarthritis with mtreatment MRI found a diffuse hyperintensity involving bilaterally the white matter of the occipital, parietal and frontal lobes on t2. MRI additionally found small ischemic lesions in the pons and medial left thalamus while on mtreatment complained about visuospatial disturbances (in article), cognition progressively worsened and was then admitted. Neurological exams found mild weakness in right limbs with ipsilateral increase of deep reflexes and babinski sign, also limb ideomotor apraxia during the first neuropsych evaluation, patient was poorly cooperative, disorientated in time and space, slow in language and motor actions, partially aware of cognitive disturbances, and complained of distal arm movement difficulties. Spontaneous language was fluent but was frequent with word-finding and difficulty constructing sentences. Neuropsych exams showed serious impairment in language comprehension, recognition of degraded figures, spatial exploration, visuomotor coordination, constructive praxis, set shifting, planning, cognitive estimation, visuospatial reasoning, working and long-term memory. Csf analysis found slight increase of the total proteins (64 ml/dl) and albumin (50 mg/dl). Hematological exams found increased cholesterol and plasmatic homocystein (14.90 µmol/l). Arylsulphatases a, beta-galactosidases and cerebrosides beta-galactosidases were in the normal range. Homocysteinemia was 14.9 µl/l, mthfr a1298c and mthfr c_t677 were aa-1298 and tt-677 respectively. Psen1, psen2, app and tau genes were negative. Mtreatment was stopped 2 months MRI follow-up were unchanged
Remission Characteristics
"6 months after stopping the mtreatment, patient was alright, oriented, and aware of the clinical situation. Spontaneous speech was ""correct"" in linguistic aspects. Verbal comprehension, attention, spatial exploration, visuomotor coordination, visuomotor abstract reasoning, set shifting, cognitive estimation, working memory and long-term all significantly improved (still impairment in planning, constructive praxis, and recognition of degraded figures) MRI follow-up after 2 years showed normal neuropsych profile and a partial regression of white matter abnormalities"
Treatment & Mechanisms
Proposed Remission Mechanisms
Withdrawal of mtreatment
Clinical Treatment
Methotrexate, cyclosporine, prednisone, salazopyearsin
Non-Clinical Treatment
Ending mtreatment treatment