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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。
One 20-year-old male received 2 cycles of high-dose methotrexate (8 g / m2) chemotherapy for osteosarcoma. On the 7th day after the second chemotherapy, the patient suddenly had poor speech, left numbness, nausea and weakness, and gradually progressed to aphasia. Both upper limbs were stiff and their lower limbs were numb. Laboratory tests: white blood cell count 12.5 × 109 / L, red blood cell count 3.6 × 1012 / L, hemoglobin 111 g / L, platelet count 101 × 109 / L. Head CT scan no abnormalities. Give oxygen. About 3 h after the symptoms improved. On the second day afternoon, patients showed similar symptoms without any incentive. Brain magnetic resonance imaging, diffusion-weighted imaging, EEG, Doppler ultrasound, carotid ultrasound were normal. Intravenous cinepazide maleate and citicoline, symptoms disappeared after 2 d.