{"id":"https://openalex.org/W7225155276","doi":"https://doi.org/10.1093/rap/rkag113.061","title":"P031 Lost for words: reversible neurotoxicity in a patient with vasculitis","display_name":"P031 Lost for words: reversible neurotoxicity in a patient with vasculitis","publication_year":2026,"publication_date":"2026-11-01","ids":{"openalex":"https://openalex.org/W7225155276","doi":"https://doi.org/10.1093/rap/rkag113.061"},"language":"en","primary_location":{"id":"doi:10.1093/rap/rkag113.061","doi":"https://doi.org/10.1093/rap/rkag113.061","is_oa":true,"landing_page_url":"https://doi.org/10.1093/rap/rkag113.061","pdf_url":"https://academic.oup.com/rheumap/article-pdf/10/Supplement_1/rkag113.061/72372016/rkag113.061.pdf","source":{"id":"https://openalex.org/S2735938563","display_name":"Rheumatology Advances in Practice","issn_l":"2514-1775","issn":["2514-1775"],"is_oa":true,"is_in_doaj":true,"is_core":true,"listed_in":["cwts-core","doaj","jufo-1","ki-jl-1","norway-1","oarl","poland-20","russia-white-list-3","vabb-shw"],"host_organization":"https://openalex.org/P4310311648","host_organization_name":"Oxford University Press","host_organization_lineage":["https://openalex.org/P4310311648","https://openalex.org/P4310311647"],"host_organization_lineage_names":["Oxford University Press","University of Oxford"],"type":"journal"},"license":"cc-by","license_id":"https://openalex.org/licenses/cc-by","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Rheumatology Advances in Practice","raw_type":"journal-article"},"volume":null,"type":"conference-abstract","is_traditional":false,"indexed_in":["crossref","doaj"],"open_access":{"is_oa":true,"oa_status":"gold","oa_url":"https://academic.oup.com/rheumap/article-pdf/10/Supplement_1/rkag113.061/72372016/rkag113.061.pdf","any_repository_has_fulltext":true},"authorships":[{"author_position":"first","author":{"id":"https://openalex.org/A5134781250","display_name":"Shreya Sanjaykumar Kalyani","orcid":null,"observed_orcids":[]},"institutions":[{"id":"https://openalex.org/I4210092187","display_name":"Basingstoke and North Hampshire Hospital","ror":"https://ror.org/01bbyhp53","country_code":"GB","type":"healthcare","lineage":["https://openalex.org/I312843336","https://openalex.org/I4210092187"]}],"countries":["GB"],"is_corresponding":false,"raw_author_name":"Shreya Sanjaykumar Kalyani","raw_affiliation_strings":["Basingstoke and North Hampshire Hospitals NHS Trust , Basingstoke,"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Basingstoke and North Hampshire Hospitals NHS Trust , Basingstoke,","institution_ids":["https://openalex.org/I4210092187"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5118808875","display_name":"Rashmikaa Netyam","orcid":null,"observed_orcids":[]},"institutions":[{"id":"https://openalex.org/I4210092187","display_name":"Basingstoke and North Hampshire Hospital","ror":"https://ror.org/01bbyhp53","country_code":"GB","type":"healthcare","lineage":["https://openalex.org/I312843336","https://openalex.org/I4210092187"]}],"countries":["GB"],"is_corresponding":false,"raw_author_name":"Rashmikaa Netyam","raw_affiliation_strings":["Basingstoke and North Hampshire Hospitals NHS Trust , Basingstoke,"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Basingstoke and North Hampshire Hospitals NHS Trust , Basingstoke,","institution_ids":["https://openalex.org/I4210092187"]}]},{"author_position":"last","author":{"id":"https://openalex.org/A5108922509","display_name":"Mariam Malik","orcid":null,"observed_orcids":[]},"institutions":[{"id":"https://openalex.org/I4210092187","display_name":"Basingstoke and North Hampshire Hospital","ror":"https://ror.org/01bbyhp53","country_code":"GB","type":"healthcare","lineage":["https://openalex.org/I312843336","https://openalex.org/I4210092187"]}],"countries":["GB"],"is_corresponding":false,"raw_author_name":"Mariam Malik","raw_affiliation_strings":["Basingstoke and North Hampshire Hospitals NHS Trust , Basingstoke,"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Basingstoke and North Hampshire Hospitals NHS Trust , Basingstoke,","institution_ids":["https://openalex.org/I4210092187"]}]}],"institutions":[],"countries_distinct_count":1,"institutions_distinct_count":1,"corresponding_author_ids":[],"corresponding_institution_ids":["https://openalex.org/I4210092187"],"apc_list":{"value":2255,"currency":"GBP","value_usd":2974},"apc_paid":{"value":2255,"currency":"GBP","value_usd":2974},"fwci":null,"has_fulltext":true,"cited_by_count":0,"citation_normalized_percentile":null,"cited_by_percentile_year":null,"biblio":{"volume":"10","issue":"Supplement_1","first_page":null,"last_page":null},"is_retracted":false,"is_paratext":false,"is_xpac":false,"primary_topic":{"id":"https://openalex.org/T10697","display_name":"Vasculitis and related conditions","score":0.9814000129699707,"subfield":{"id":"https://openalex.org/subfields/2745","display_name":"Rheumatology"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},"topics":[{"id":"https://openalex.org/T10697","display_name":"Vasculitis and related conditions","score":0.9814000129699707,"subfield":{"id":"https://openalex.org/subfields/2745","display_name":"Rheumatology"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},{"id":"https://openalex.org/T10200","display_name":"Rheumatoid Arthritis Research and Therapies","score":0.003100000089034438,"subfield":{"id":"https://openalex.org/subfields/2745","display_name":"Rheumatology"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},{"id":"https://openalex.org/T11735","display_name":"Peripheral Neuropathies and Disorders","score":0.0026000000070780516,"subfield":{"id":"https://openalex.org/subfields/2728","display_name":"Clinical Neurology"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}}],"keywords":[{"id":"https://openalex.org/keywords/methotrexate","display_name":"methotrexate","score":0.8999999761581421},{"id":"https://openalex.org/keywords/drug-induced-neurotoxicity","display_name":"drug-induced neurotoxicity","score":0.878000020980835},{"id":"https://openalex.org/keywords/giant-cell-arteritis","display_name":"giant cell arteritis","score":0.9419999718666077},{"id":"https://openalex.org/keywords/polymyalgia-rheumatica","display_name":"polymyalgia rheumatica","score":0.9760000109672546},{"id":"https://openalex.org/keywords/speech-disturbance","display_name":"speech disturbance","score":0.6620000004768372},{"id":"https://openalex.org/keywords/word-finding-difficulties","display_name":"word-finding difficulties","score":0.7860000133514404},{"id":"https://openalex.org/keywords/reversible-neurotoxicity","display_name":"reversible neurotoxicity","score":0.7609999775886536},{"id":"https://openalex.org/keywords/vertebral-artery-stenosis","display_name":"vertebral artery stenosis","score":0.8209999799728394},{"id":"https://openalex.org/keywords/vasculitis","display_name":"vasculitis","score":0.6179999709129333},{"id":"https://openalex.org/keywords/adverse-drug-reactions","display_name":"adverse drug reactions","score":0.4410000145435333},{"id":"https://openalex.org/keywords/corticosteroid-tapering","display_name":"corticosteroid tapering","score":0.5630000233650208},{"id":"https://openalex.org/keywords/ct-angiography","display_name":"CT angiography","score":0.5600000023841858},{"id":"https://openalex.org/keywords/cerebral-small-vessel-disease","display_name":"cerebral small vessel disease","score":0.6359999775886536},{"id":"https://openalex.org/keywords/elderly-patients","display_name":"elderly patients","score":0.44699999690055847},{"id":"https://openalex.org/keywords/prednisolone","display_name":"prednisolone","score":0.5960000157356262},{"id":"https://openalex.org/keywords/oral-candidiasis","display_name":"oral candidiasis","score":0.5799999833106995}],"concepts":[{"id":"https://openalex.org/C71924100","wikidata":"https://www.wikidata.org/wiki/Q11190","display_name":"Medicine","level":0,"score":0.965399980545044},{"id":"https://openalex.org/C2776712624","wikidata":"https://www.wikidata.org/wiki/Q707816","display_name":"Giant cell arteritis","level":4,"score":0.7419000267982483},{"id":"https://openalex.org/C2776015282","wikidata":"https://www.wikidata.org/wiki/Q644318","display_name":"Vasculitis","level":3,"score":0.7361000180244446},{"id":"https://openalex.org/C2781059491","wikidata":"https://www.wikidata.org/wiki/Q422232","display_name":"Methotrexate","level":2,"score":0.7179999947547913},{"id":"https://openalex.org/C2780079024","wikidata":"https://www.wikidata.org/wiki/Q1752891","display_name":"Polymyalgia rheumatica","level":5,"score":0.7102000117301941},{"id":"https://openalex.org/C2781343717","wikidata":"https://www.wikidata.org/wiki/Q1751810","display_name":"Arteritis","level":2,"score":0.5029000043869019},{"id":"https://openalex.org/C2779491297","wikidata":"https://www.wikidata.org/wiki/Q3338704","display_name":"Neurotoxicity","level":3,"score":0.4916999936103821},{"id":"https://openalex.org/C2780645631","wikidata":"https://www.wikidata.org/wiki/Q671554","display_name":"Stroke (engine)","level":2,"score":0.4900999963283539},{"id":"https://openalex.org/C126322002","wikidata":"https://www.wikidata.org/wiki/Q11180","display_name":"Internal medicine","level":1,"score":0.4471000134944916},{"id":"https://openalex.org/C2778754783","wikidata":"https://www.wikidata.org/wiki/Q191557","display_name":"Cerebral vasculitis","level":4,"score":0.43860000371932983},{"id":"https://openalex.org/C2777575956","wikidata":"https://www.wikidata.org/wiki/Q187255","display_name":"Rheumatoid arthritis","level":2,"score":0.4101000130176544},{"id":"https://openalex.org/C90924648","wikidata":"https://www.wikidata.org/wiki/Q120569","display_name":"Gastroenterology","level":1,"score":0.3783999979496002},{"id":"https://openalex.org/C141071460","wikidata":"https://www.wikidata.org/wiki/Q40821","display_name":"Surgery","level":1,"score":0.35600000619888306},{"id":"https://openalex.org/C2778570526","wikidata":"https://www.wikidata.org/wiki/Q653197","display_name":"Rash","level":2,"score":0.353300005197525},{"id":"https://openalex.org/C2779161974","wikidata":"https://www.wikidata.org/wiki/Q815819","display_name":"Atrial fibrillation","level":2,"score":0.3433000147342682},{"id":"https://openalex.org/C2776839432","wikidata":"https://www.wikidata.org/wiki/Q954845","display_name":"Statin","level":2,"score":0.3402000069618225},{"id":"https://openalex.org/C2778720950","wikidata":"https://www.wikidata.org/wiki/Q424972","display_name":"Prednisone","level":2,"score":0.3328000009059906},{"id":"https://openalex.org/C16568411","wikidata":"https://www.wikidata.org/wiki/Q83042","display_name":"Neurology","level":2,"score":0.33149999380111694},{"id":"https://openalex.org/C197934379","wikidata":"https://www.wikidata.org/wiki/Q2047938","display_name":"Adverse effect","level":2,"score":0.32109999656677246},{"id":"https://openalex.org/C2777849778","wikidata":"https://www.wikidata.org/wiki/Q410237","display_name":"Clopidogrel","level":3,"score":0.3206000030040741},{"id":"https://openalex.org/C16005928","wikidata":"https://www.wikidata.org/wiki/Q171171","display_name":"Dermatology","level":1,"score":0.30799999833106995},{"id":"https://openalex.org/C164705383","wikidata":"https://www.wikidata.org/wiki/Q10379","display_name":"Cardiology","level":1,"score":0.304500013589859},{"id":"https://openalex.org/C42219234","wikidata":"https://www.wikidata.org/wiki/Q131130","display_name":"Anesthesia","level":1,"score":0.29429998993873596},{"id":"https://openalex.org/C2777374719","wikidata":"https://www.wikidata.org/wiki/Q7663822","display_name":"Systemic vasculitis","level":4,"score":0.29249998927116394},{"id":"https://openalex.org/C2778094803","wikidata":"https://www.wikidata.org/wiki/Q410061","display_name":"Amiodarone","level":3,"score":0.28189998865127563},{"id":"https://openalex.org/C2776301958","wikidata":"https://www.wikidata.org/wiki/Q407431","display_name":"Warfarin","level":3,"score":0.2782999873161316},{"id":"https://openalex.org/C142724271","wikidata":"https://www.wikidata.org/wiki/Q7208","display_name":"Pathology","level":1,"score":0.26739999651908875},{"id":"https://openalex.org/C2776527422","wikidata":"https://www.wikidata.org/wiki/Q745162","display_name":"Polyarteritis nodosa","level":4,"score":0.2644999921321869},{"id":"https://openalex.org/C2780505380","wikidata":"https://www.wikidata.org/wiki/Q7142931","display_name":"Past medical history","level":2,"score":0.26019999384880066},{"id":"https://openalex.org/C187212893","wikidata":"https://www.wikidata.org/wiki/Q123028","display_name":"Pediatrics","level":1,"score":0.2535000145435333},{"id":"https://openalex.org/C171614378","wikidata":"https://www.wikidata.org/wiki/Q5064093","display_name":"Cerebral arteries","level":2,"score":0.2531999945640564},{"id":"https://openalex.org/C2780581723","wikidata":"https://www.wikidata.org/wiki/Q775940","display_name":"Diplopia","level":2,"score":0.25029999017715454}],"mesh":[],"locations_count":2,"locations":[{"id":"doi:10.1093/rap/rkag113.061","doi":"https://doi.org/10.1093/rap/rkag113.061","is_oa":true,"landing_page_url":"https://doi.org/10.1093/rap/rkag113.061","pdf_url":"https://academic.oup.com/rheumap/article-pdf/10/Supplement_1/rkag113.061/72372016/rkag113.061.pdf","source":{"id":"https://openalex.org/S2735938563","display_name":"Rheumatology Advances in Practice","issn_l":"2514-1775","issn":["2514-1775"],"is_oa":true,"is_in_doaj":true,"is_core":true,"listed_in":["cwts-core","doaj","jufo-1","ki-jl-1","norway-1","oarl","poland-20","russia-white-list-3","vabb-shw"],"host_organization":"https://openalex.org/P4310311648","host_organization_name":"Oxford University Press","host_organization_lineage":["https://openalex.org/P4310311648","https://openalex.org/P4310311647"],"host_organization_lineage_names":["Oxford University Press","University of Oxford"],"type":"journal"},"license":"cc-by","license_id":"https://openalex.org/licenses/cc-by","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Rheumatology Advances in Practice","raw_type":"journal-article"},{"id":"pmh:oai:pubmedcentral.nih.gov:13728628","doi":null,"is_oa":true,"landing_page_url":"https://pmc.ncbi.nlm.nih.gov/articles/PMC13728628/","pdf_url":"https://pmc.ncbi.nlm.nih.gov/articles/PMC13728628/pdf/rkag113.061.pdf","source":{"id":"https://openalex.org/S2764455111","display_name":"PubMed Central","issn_l":null,"issn":null,"is_oa":true,"is_in_doaj":false,"is_core":false,"listed_in":[],"host_organization":"https://openalex.org/I1299303238","host_organization_name":"National Institutes of Health","host_organization_lineage":["https://openalex.org/I1299303238"],"host_organization_lineage_names":[],"type":"repository"},"license":"cc-by","license_id":"https://openalex.org/licenses/cc-by","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Rheumatol Adv Pract","raw_type":"Text"}],"best_oa_location":{"id":"doi:10.1093/rap/rkag113.061","doi":"https://doi.org/10.1093/rap/rkag113.061","is_oa":true,"landing_page_url":"https://doi.org/10.1093/rap/rkag113.061","pdf_url":"https://academic.oup.com/rheumap/article-pdf/10/Supplement_1/rkag113.061/72372016/rkag113.061.pdf","source":{"id":"https://openalex.org/S2735938563","display_name":"Rheumatology Advances in Practice","issn_l":"2514-1775","issn":["2514-1775"],"is_oa":true,"is_in_doaj":true,"is_core":true,"listed_in":["cwts-core","doaj","jufo-1","ki-jl-1","norway-1","oarl","poland-20","russia-white-list-3","vabb-shw"],"host_organization":"https://openalex.org/P4310311648","host_organization_name":"Oxford University Press","host_organization_lineage":["https://openalex.org/P4310311648","https://openalex.org/P4310311647"],"host_organization_lineage_names":["Oxford University Press","University of Oxford"],"type":"journal"},"license":"cc-by","license_id":"https://openalex.org/licenses/cc-by","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Rheumatology Advances in Practice","raw_type":"journal-article"},"sustainable_development_goals":[{"id":"https://metadata.un.org/sdg/3","score":1.0,"display_name":"Good health and well-being"}],"study_designs":[],"awards":[],"funders":[],"has_content":{"grobid_xml":true,"pdf":true},"content_urls":{"pdf":"https://content.openalex.org/works/W7225155276.pdf","grobid_xml":"https://content.openalex.org/works/W7225155276.grobid-xml"},"referenced_works_count":0,"referenced_works":[],"related_works":["https://openalex.org/W2981152517","https://openalex.org/W2166275288","https://openalex.org/W2137140444","https://openalex.org/W7164148917","https://openalex.org/W2423003288","https://openalex.org/W2052772994","https://openalex.org/W2011178735","https://openalex.org/W4303199226","https://openalex.org/W1981573010","https://openalex.org/W2177363226"],"abstract_inverted_index":{"Abstract":[0],"Introduction":[1],"Methotrexate":[2,462],"is":[3,515],"a":[4,56,63,81,161,242,372],"widely":[5],"used":[6,409],"disease-modifying":[7],"agent":[8],"in":[9,43,49,252,395,410,455,494,507,530],"rheumatology,":[10],"prescribed":[11],"for":[12,180,317,416],"various":[13],"inflammatory":[14,486],"conditions":[15],"including":[16,67],"giant":[17],"cell":[18],"arteritis":[19],"(GCA).":[20],"Although":[21,386],"side":[22,319],"effects":[23,403],"of":[24,65,76,83,120,150,192,199,378,384,480],"methotrexate":[25,126,137,314,362,481],"are":[26,32,39,433],"common,":[27],"speech":[28,240,381,418],"disturbance":[29,382,474],"and":[30,38,89,99,129,143,171,175,229,238,257,273,310,331,363,422,435,450,488,505,542],"neurotoxicity":[31,425,464],"rare":[33,373],"with":[34,80,97,146,201,349,390,407,468,534,539],"low-dose":[35,469],"oral":[36,169,470],"administration":[37,394],"more":[40,387],"typically":[41],"seen":[42],"chemotherapeutic":[44],"or":[45,153,282,351,392],"intrathecal":[46,393],"preparations,":[47],"particularly":[48,429],"the":[50,74,190,197,253,261,270,342,413,495,527,536],"paediatric":[51],"population.":[52],"This":[53,369],"can":[54,404,443,465,501],"pose":[55],"clinical":[57,148,292,496],"dilemma,":[58],"as":[59,511],"symptoms":[60,122,165,326,343,355,436],"may":[61,475],"mimic":[62],"range":[64],"differentials,":[66],"cerebrovascular":[68,420],"events.":[69],"Case":[70],"description":[71],"We":[72],"present":[73],"case":[75,266,370,399],"an":[77,477],"84-year-old":[78],"lady":[79],"background":[82],"atrial":[84],"fibrillation":[85],"on":[86,107,114],"anticoagulation,":[87],"hypertension,":[88],"mild":[90,300],"left":[91,262],"ventricular":[92],"dysfunction,":[93],"who":[94],"was":[95,105,112,127,132,212,245,267,294],"diagnosed":[96],"GCA":[98,104,121,152],"new-onset":[100],"polymyalgia":[101],"rheumatica":[102],"(PMR).":[103],"confirmed":[106],"temporal":[108],"artery":[109,256],"biopsy.":[110],"She":[111],"commenced":[113],"prednisolone,":[115],"but":[116,374],"due":[117,279,360],"to":[118,168,194,209,277,280,315,358,361,517,544],"recurrence":[119],"during":[123],"steroids":[124],"tapering,":[125],"introduced,":[128],"steroid":[130],"weaning":[131],"continued.":[133],"Six":[134],"weeks":[135],"into":[136],"treatment,":[138],"she":[139],"developed":[140],"word-finding":[141],"difficulties":[142],"gastric":[144],"upset,":[145],"no":[147],"features":[149],"active":[151,352],"PMR.":[154],"A":[155],"same-day":[156],"emergency":[157],"care":[158],"review":[159,309],"included":[160],"reassuring":[162],"CT":[163,243],"head;":[164],"were":[166,178,232,275,334,347,356],"attributed":[167],"candidiasis":[170],"steroid-related":[172],"effects.":[173,320],"Neurology":[174],"stroke":[176,337,350],"referrals":[177],"made":[179],"further":[181],"evaluation.":[182],"Bloods":[183],"showed":[184,299],"CRP":[185],"dropped":[186],"from":[187,207],"74":[188],"at":[189,196,260,269],"time":[191,198],"diagnosis":[193],"2":[195],"presentation":[200],"her":[202,235,325],"new":[203],"symptoms;":[204],"ESR":[205],"fell":[206],"93":[208],"10.":[210],"Haemoglobin":[211],"118":[213],"g/L;":[214],"WCC":[215],"9.2":[216],"\u00d7":[217,221],"10\u2079/L;":[218,222],"platelets":[219],"330":[220],"eGFR":[223],"67mls/min;":[224],"liver":[225],"function,":[226],"serum":[227],"electrophoresis,":[228],"cholesterol":[230],"levels":[231],"normal.":[233],"Given":[234,412],"vasculitis":[236],"history":[237,293],"recent":[239],"disturbance,":[241],"angiogram":[244],"performed,":[246],"which":[247],"revealed":[248],"near-complete":[249],"contrast":[250],"loss":[251],"right":[254],"vertebral":[255,263],"50%":[258],"stenosis":[259],"origin.":[264],"The":[265,336],"discussed":[268],"Neuro-radiology":[271],"MDT":[272],"findings":[274,346],"thought":[276],"be":[278,288,359,427,476,492,502],"atheroma":[281],"chronic":[283],"dissection.":[284],"Vasculitis":[285],"could":[286],"not":[287,295],"ruled":[289],"out,":[290],"though":[291],"supportive.":[296],"MRI":[297],"head":[298],"small":[301],"vessel":[302],"disease.":[303],"Her":[304,354],"GP,":[305],"while":[306],"awaiting":[307],"specialist":[308,323,338],"investigations,":[311,446],"temporarily":[312],"withheld":[313],"assess":[316],"drug-related":[318],"At":[321],"neurology":[322],"review,":[324],"had":[327],"fully":[328],"resolved.":[329],"Imaging":[330],"test":[332],"results":[333],"reassuring.":[335],"concluded":[339],"that":[340,401],"neither":[341],"nor":[344],"imaging":[345,489],"consistent":[348],"vasculitis.":[353],"felt":[357],"resolved":[364],"completely":[365],"upon":[366,438],"withdrawal.":[367],"Discussion":[368],"highlights":[371],"important":[375],"adverse":[376],"effect":[377],"methotrexate:":[379],"transient":[380],"suggestive":[383],"neurotoxicity.":[385],"commonly":[388],"reported":[389],"high-dose":[391],"oncology":[396],"settings,":[397],"this":[398,531],"demonstrates":[400],"neurotoxic":[402],"also":[405],"occur":[406,466],"doses":[408],"rheumatology.":[411],"broad":[414],"differential":[415],"acute":[417],"disturbance\u2014including":[419],"events":[421],"disease":[423],"relapse\u2014methotrexate-induced":[424],"should":[426,491],"considered,":[428],"when":[430],"other":[431],"investigations":[432],"unremarkable":[434],"resolve":[437],"drug":[439,453],"cessation.":[440],"Early":[441],"recognition":[442],"prevent":[444],"unnecessary":[445],"support":[447],"safer":[448],"prescribing,":[449],"guide":[451],"appropriate":[452],"monitoring":[454],"vulnerable":[456],"populations.":[457],"Key":[458],"learning":[459],"points":[460],"1.":[461],"related":[463],"even":[467],"therapy.":[471],"2.":[472],"Speech":[473],"isolated":[478],"manifestation":[479],"toxicity.":[482],"3.":[483],"Clinical":[484],"assessment,":[485],"markers,":[487],"abnormalities":[490],"interpreted":[493],"context.":[497],"4.":[498],"Drug":[499],"withdrawal":[500],"both":[503],"diagnostic":[504,524,540],"therapeutic":[506],"some":[508],"contexts":[509],"such":[510],"these":[512],"if":[513],"it":[514],"safe":[516],"do":[518],"so.":[519],"5.":[520],"Multidisciplinary":[521],"collaboration":[522],"improves":[523],"accuracy":[525],"-":[526],"neurologist\u2019s":[528],"assessment":[529],"patient":[532],"helped":[533],"pinning":[535],"diagnoses":[537],"down":[538],"confidence":[541],"lead":[543],"favourable":[545],"outcomes.":[546]},"counts_by_year":[],"updated_date":"2026-11-07T11:25:07.637180","created_date":"2026-11-04T00:00:00"}