Irreversible Methotrexate Induced Luckencephalopathy Presenting as Recurrent Stroke like Episodes: A Case Report and Brief Literature Review

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Hind A. Alnajashi


Methotrexate, Leukoencephalopathy, Diffusion weighted image, Stroke


A case of young female with leukemia on multiple chemotherapeutic agents including intrathecal methotrexate developed an attack of transient neurological deficit that improved spontaneously, followed by a second attack that was irreversible. MRI finding showed multiple area of increased signal intensity compatible with cytotoxic edema. These finding was suggestive of methotrexate induce toxic leukoencephalopathy. A critical decision was needed regarding discontinuing methotrexate from the chemotherapy protocol. The case is followed by a brief review about methotrexate induced leukoencephalopathy and the best way of its early detection and prevention.

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