Central nervous system relapse prevention through intrathecal and intravenous methotrexate (MTX) administration is a crucial aspect of treatment in acute lymphoblastic leukemia. However, neurotoxicity-induced leukoencephalopathy is a significant concern. Neurological symptoms associated with MTX can appear as subacute leukoencephalopathies, which manifest as a stroke-like syndrome, consisting of paralysis, seizures, consciousness disturbances, and dysarthria. These symptoms persist for a few days, presenting with fluctuating severity and location. Characteristic findings in bilateral white matter are observed on diffusion-weighted magnetic resonance imaging. Symptoms typically improve naturally within a few days although supportive therapy remains the primary treatment. The efficacy of drug administration is not established. Therapy should be continued if clinical improvements are achieved following the initial neurological event regarding MTX re-administrations after symptom improvement. However, careful consideration is required for each patient because symptoms may reoccur or persist and long-term effects remained unclear.
Keywords: Chemotherapy; Leukemia; Leukoencephalopathy; Methotrexate.