Methotrexate-induced toxic leukoencephalopathy: an uncommon stroke mimic

  • Roderick P. P. W. M. MaasEmail author
  • Sjoert A. H. Pegge
  • Dorothea Evers
  • Anusha van Samkar
  • Catharina J. M. Klijn
Letter to the Editor

Dear Sir,

Focal neurologic deficits in immunocompromised leukemia patients can be caused by a variety of conditions, among them central nervous system (CNS) involvement, cerebral infarction, intracranial hemorrhage, and (opportunistic) infections [1]. We here describe a young woman with acute leukemia who presented with a stroke-like syndrome due to toxic methotrexate-induced leukoencephalopathy. As methotrexate is commonly administered intrathecally, clinicians should be aware of this rare side effect. Timely recognition of the typical MRI abnormalities can prevent unnecessary diagnostic procedures and has implications for treatment and prognosis.

A 19-year-old woman was admitted to the emergency department because of dysarthria and uncoordinated gait that had commenced the evening before presentation. She also reported numbness and paresthesias in the left arm and difficulty dressing herself due to left hand weakness. There was no headache, nausea, vomiting, diplopia, or reduced...


Compliance with ethical standards

Conflict of interest

Roderick Maas, Sjoert Pegge, Dorothea Evers, and Anusha van Samkar report no disclosures.

Karin Klijn is supported by a clinical established investigator grant from the Dutch Heart Foundation (2012T077) and an Aspasia grant from ZonMw.

Ethical approval

This article does not contain any studies with human participants performed by any of the authors.


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Copyright information

© Fondazione Società Italiana di Neurologia 2019

Authors and Affiliations

  1. 1.Department of Neurology and Donders Institute for Brain, Cognition, and BehaviourRadboud University Medical CenterNijmegenthe Netherlands
  2. 2.Department of Radiology and Nuclear MedicineRadboud University Medical CenterNijmegenthe Netherlands
  3. 3.Department of HematologyRadboud University Medical CenterNijmegenthe Netherlands
  4. 4.Department of NeurologyCanisius Wilhelmina HospitalNijmegenthe Netherlands

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