Methotrexate-induced Transient Encephalopathy in an Adolescent and Young Adult Patient with Acute Lymphoblastic Leukemia

Intern Med. 2021 Jul 1;60(13):2115-2118. doi: 10.2169/internalmedicine.5937-20. Epub 2021 Feb 1.


A 17-year-old girl was diagnosed with acute lymphoblastic leukemia (ALL). After the administration of high-dose methotrexate (MTX) or intrathecal MTX, the patient experienced transient hemiparesis and motor aphasia. Diffusion-weighted magnetic resonance imaging showed a high-intensity lesion in the bilateral centrum semiovale, and a vasospasm was detected in the proximal segment of bilateral A1 on magnetic resonance angiography. Edaravone was administered, and leucovorin rescue treatment was continued; eventually, the patient's neurological symptoms completely resolved. This finding suggested that vasospasm might be a mechanism underlying MTX-induced transient encephalopathy in adolescent and young adult patients with ALL.

Keywords: acute lymphoblastic leukemia; adolescent and young adult; methotrexate; transient encephalopathy; vasospasm.

Publication types

  • Case Reports

MeSH terms

  • Adolescent
  • Brain Diseases*
  • Diffusion Magnetic Resonance Imaging
  • Female
  • Humans
  • Methotrexate / adverse effects
  • Paresis
  • Precursor Cell Lymphoblastic Leukemia-Lymphoma* / drug therapy
  • Young Adult


  • Methotrexate