Methotrexate-induced Subacute Encephalopathy That Showed No Abnormalities on Magnetic Resonance Imaging Soon after Symptom Appearance

• Published in: Internal Medicine Vol. 62; no. 15; pp. 2249 - 2252
• Main Authors: Fujisawa, Haruna, Mitsui, Yurika, Narukawa, Kensuke, Shirasugi, Yukari, Komaki, Shogo, Hao, Akihito, Matsumoto, Hideyuki, Takahashi, Tsuyoshi
• Format: Journal Article
• Language: English
• Published: Japan The Japanese Society of Internal Medicine 01.08.2023; Japan Science and Technology Agency
• Subjects: Acute lymphoblastic leukemia; acute lymphocytic leukemia; Case Report; diffusion-weighed images; Encephalopathy; Frontal lobe; Internal medicine; Lymphatic leukemia; Magnetic resonance imaging; Methotrexate; MTX-induced encephalopathy; Paralysis; methotrexate; MTX-induced encephalopathy; encephalopathy; acute lymphocytic leukemia; diffusion-weighed images
• ISSN: 0918-2918; 1349-7235
• DOI: 10.2169/internalmedicine.0855-22

A 21-year-old woman was diagnosed with acute lymphoblastic leukemia. After the administration of intrathecal methotrexate (MTX), the patient experienced dysarthria and paralysis for one hour. Magnetic resonance imaging (MRI) performed one hour from the onset and just before symptoms disappeared revealed no abnormalities. The next day, the symptoms appeared again, and diffusion-weighed MRI revealed a high-intensity area in the left frontal lobe. The patient was diagnosed with MTX-induced encephalopathy. This case suggested that MRI performed as soon as symptoms appear might show normal findings in MTX-induced encephalopathy.