Authors : Dr. Gorle Siva Sai; Dr. Tavva Pradeep; Dr. Kanduri Soumya; Dr. Sivani Reddy Demali; Dr. Bhamidipaty Kanaka Durga Prasad

Volume/Issue : Volume 11 - 2026, Issue 7 - July

Google Scholar : https://tinyurl.com/3947d38a

Scribd : https://tinyurl.com/ms7599vc

DOI : https://doi.org/10.38124/ijisrt/26jul641

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Abstract : With the increasing use of thrombolytic therapy for acute ischemic stroke within the 4.5 hour therapeutic golden hour window, timely and accurate diagnosis is crucial. As stroke mimics, though uncommon, may receive unnecessary thrombolysis and face risks such as hemorrhagic complications. Methotrexate, widely used in the treatment of malignant and autoimmune disorders can rarely cause neurotoxicity. Methotrexate-induced leukoencephalopathy is an important stroke mimic presenting with acute focal neurological deficits that can be mistaken for ischemic stroke creating diagnostic and therapeutic challenges. We report a 32-year-old male with B-cell acute lymphoblastic leukemia who developed sudden neurological deficits, 2 weeks after completing 4 weeks of methotrexate therapy. Initial clinical assessment suggested acute stroke. Brain MRI demonstrated bilateral white matter diffusion restriction not confined to a vascular territory. On contrast-enhanced imaging, no abnormal enhancement was seen suggesting white matter disease favouring methotrexateinduced leukoencephalopathy. This case highlights the potentially severe and fatal course of methotrexate neurotoxicity and underscores the need for high suspicion and recognition of characteristic clinical and imaging features to guide timely management and avoid inappropriate interventions.

Keywords : Methotrexate, Leukoencephalopathy, Stroke Mimic, Neurotoxicity, MRI.

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