Acute methotrexate-induced stroke-like syndrome in adolescent acute lymphoblastic leukemia

Abstract: Methotrexate (MTX), a folic acid antagonist, is an important agent in the management of acute lymphoblastic leukemia (ALL), in both adult and pediatric patients. Neurotoxicity is a rare but well-described complication after intrathecal and intravenous MTX administration. We report a 15-year-old girl with B-cell ALL with no central nervous system (CNS) involvement, who developed a sudden left-sided hemiparesis five days after intravenous high-dose MTX and nine days following the eighth intrathecal (IT) MTX. A brain MRI revealed a focal area of restricted diffusion in the right corona radiata, and her symptoms had recovered spontaneously and completely on the same day, which was highly suggestive of being related to methotrexate.