{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,10]],"date-time":"2026-07-10T09:37:13Z","timestamp":1783676233551,"version":"3.55.0"},"reference-count":29,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2014,7,2]],"date-time":"2014-07-02T00:00:00Z","timestamp":1404259200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Neuropathology"],"published-print":{"date-parts":[[2014,12]]},"abstract":"<jats:p>The patient was a 70\u2010year\u2010old woman with lymphoplasmacytic lymphoma which showed a predominantly diffuse involvement of the bone marrow and kidney. Because atypical lymphocytes appeared in the cerebrospinal fluid, the intrathecal administration of methotrexate (<jats:styled-content style=\"fixed-case\">MTX<\/jats:styled-content>) and cytosine arabinoside (<jats:styled-content style=\"fixed-case\">A<\/jats:styled-content>ra\u2010<jats:styled-content style=\"fixed-case\">C<\/jats:styled-content>) was repeated several times. The patient developed flaccid paraplegia 8 months after the beginning of intrathecal administration, and died 4 months later. Autopsy demonstrated extensive transverse necrosis involving the lower thoracic cord and marked vacuolar degeneration of the white matter of the cervical, upper thoracic and lumbo\u2010sacral cord. Focal vacuolar degeneration of the white matter was also noted in the left parietal lobe. Although vacuolar degeneration of the white matter is a common feature in <jats:styled-content style=\"fixed-case\">MTX<\/jats:styled-content> myelopathy, extensive transverse necrosis is rare. In the present case, an overlapping of two mechanisms, that is, injury of vascular endothelial cells and the direct toxic effect of <jats:styled-content style=\"fixed-case\">MTX<\/jats:styled-content> and <jats:styled-content style=\"fixed-case\">A<\/jats:styled-content>ra\u2010<jats:styled-content style=\"fixed-case\">C<\/jats:styled-content> on the white matter, probably played a crucial role in the pathogenesis of severe myelopathy. Because severe myelopathy occurs infrequently, considering the large number of patients receiving the intrathecal administration of <jats:styled-content style=\"fixed-case\">MTX<\/jats:styled-content>, it is possible that a constitutional predisposition or abnormal sensitivity to <jats:styled-content style=\"fixed-case\">MTX<\/jats:styled-content> was involved in the pathogenesis in the present patient.<\/jats:p>","DOI":"10.1111\/neup.12135","type":"journal-article","created":{"date-parts":[[2014,7,2]],"date-time":"2014-07-02T13:37:58Z","timestamp":1404308278000},"page":"547-553","source":"Crossref","is-referenced-by-count":12,"title":["Methotrexate myelopathy with extensive transverse necrosis: Report of an autopsy case"],"prefix":"10.1111","volume":"34","author":[{"given":"Masayuki","family":"Shintaku","sequence":"first","affiliation":[{"name":"Department of Pathology Osaka Red Cross Hospital  Osaka Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nao","family":"Toyooka","sequence":"additional","affiliation":[{"name":"Department of Hematology Osaka Red Cross Hospital  Osaka Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takashi","family":"Koyama","sequence":"additional","affiliation":[{"name":"Diagnostic Radiology Osaka Red Cross Hospital  Osaka Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shunsuke","family":"Teraoka","sequence":"additional","affiliation":[{"name":"Department of Hematology Osaka Red Cross Hospital  Osaka Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mitsuru","family":"Tsudo","sequence":"additional","affiliation":[{"name":"Department of Hematology Osaka Red Cross Hospital  Osaka Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2014,7,2]]},"reference":[{"key":"e_1_2_5_2_1","doi-asserted-by":"publisher","DOI":"10.1002\/1097-0142(197502)35:2<306::AID-CNCR2820350203>3.0.CO;2-J"},{"key":"e_1_2_5_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0046-8177(78)80047-1"},{"key":"e_1_2_5_4_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00401-005-0023-y"},{"key":"e_1_2_5_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/1097-0142(197502)35:2<291::AID-CNCR2820350202>3.0.CO;2-V"},{"key":"e_1_2_5_6_1","doi-asserted-by":"publisher","DOI":"10.1002\/1097-0142(19820701)50:1<42::AID-CNCR2820500109>3.0.CO;2-M"},{"key":"e_1_2_5_7_1","doi-asserted-by":"publisher","DOI":"10.1002\/mpo.2950190309"},{"key":"e_1_2_5_8_1","first-page":"35","article-title":"Methotrexate myelopathy","volume":"77","author":"Honda D","year":"2012","journal-title":"Neurol Med (Tokyo)"},{"key":"e_1_2_5_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1440-1789.2008.00945.x"},{"key":"e_1_2_5_10_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00401-007-0214-9"},{"key":"e_1_2_5_11_1","doi-asserted-by":"publisher","DOI":"10.1007\/BF00707111"},{"key":"e_1_2_5_12_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM197310112891503"},{"key":"e_1_2_5_13_1","doi-asserted-by":"publisher","DOI":"10.1007\/BF00690468"},{"key":"e_1_2_5_14_1","doi-asserted-by":"publisher","DOI":"10.1007\/BF00294671"},{"key":"e_1_2_5_15_1","first-page":"619","article-title":"Two autopsy cases of radiation myelopathy. Consideration about the pathogenesis","volume":"15","author":"Okeda R","year":"1971","journal-title":"Adv Neurol Sci (Tokyo)"},{"key":"e_1_2_5_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/0022-510X(71)90174-2"},{"key":"e_1_2_5_17_1","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp.35.6.888"},{"key":"e_1_2_5_18_1","doi-asserted-by":"publisher","DOI":"10.1002\/1097-0142(197402)33:2<468::AID-CNCR2820330223>3.0.CO;2-F"},{"key":"e_1_2_5_19_1","doi-asserted-by":"publisher","DOI":"10.1002\/1097-0142(197809)42:3<1211::AID-CNCR2820420326>3.0.CO;2-X"},{"key":"e_1_2_5_20_1","doi-asserted-by":"publisher","DOI":"10.1002\/1097-0142(197202)29:2<370::AID-CNCR2820290217>3.0.CO;2-Z"},{"key":"e_1_2_5_21_1","first-page":"1204","article-title":"Paraplegia following intrathecal methotrexate","volume":"22","author":"Tomonaga M","year":"1978","journal-title":"Adv Neurol Sci (Tokyo)"},{"key":"e_1_2_5_22_1","doi-asserted-by":"publisher","DOI":"10.1007\/BF00691894"},{"key":"e_1_2_5_23_1","doi-asserted-by":"publisher","DOI":"10.1007\/BF00687759"},{"key":"e_1_2_5_24_1","doi-asserted-by":"publisher","DOI":"10.1212\/01.WNL.0000152840.26156.74"},{"issue":"35","key":"e_1_2_5_25_1","first-page":"1","article-title":"The myelopathy of pernicious anemia. A neuropathological reappraisal","volume":"44","author":"Pant SS","year":"1968","journal-title":"Acta Neurol Scand"},{"key":"e_1_2_5_26_1","doi-asserted-by":"publisher","DOI":"10.1215\/15228517-2008-082"},{"key":"e_1_2_5_27_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11060-009-0028-9"},{"key":"e_1_2_5_28_1","doi-asserted-by":"publisher","DOI":"10.1002\/1097-0142(197712)40:6<2817::AID-CNCR2820400611>3.0.CO;2-V"},{"key":"e_1_2_5_29_1","first-page":"60","article-title":"Arterial border zone necrosis of the spinal cord","volume":"9","author":"Wolf HK","year":"1990","journal-title":"Clin Neuropathol"},{"key":"e_1_2_5_30_1","doi-asserted-by":"publisher","DOI":"10.1097\/00005072-198407000-00006"}],"container-title":["Neuropathology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1111%2Fneup.12135","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/neup.12135","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,10,2]],"date-time":"2023-10-02T06:13:31Z","timestamp":1696227211000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/neup.12135"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2014,7,2]]},"references-count":29,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2014,12]]}},"alternative-id":["10.1111\/neup.12135"],"URL":"https:\/\/doi.org\/10.1111\/neup.12135","archive":["Portico"],"relation":{},"ISSN":["0919-6544","1440-1789"],"issn-type":[{"value":"0919-6544","type":"print"},{"value":"1440-1789","type":"electronic"}],"subject":[],"published":{"date-parts":[[2014,7,2]]}}}