Methotrexate-induced stroke-like encephalopathy in children: а clinical case
https://doi.org/10.22328/2079-5343-2026-17-1-106-112
Abstract
Methotrexate-induced stroke-like leukoencephalopathy (MISLE) is a rare form of subacute neurotoxicity associated with highdose methotrexate and may be misdiagnosed due to its close resemblance to acute ischemic stroke. We report two cases of MISLE in pediatric oncology patients who developed neurological symptoms mimicking acute ischemic stroke during combination chemotherapy at the Russian Children’s Clinical Hospital (the separate structural unit of the FSАEI HE N. I. Pirogov RNRMU MOH Russia). Urgent magnetic resonance imaging (MRI) revealed bilateral areas of diffusion restriction in both patients, which completely resolved on follow-up imaging performed 24 hours later. These cases highlight the importance of diffusion-weighted imaging (DWI) for establishing an accurate diagnosis, confirming the reversibility of pathological changes, and preventing unnecessary interventions such as thrombolytic therapy.
About the Authors
N. A. Sholokhova
Russian Medical Academy of Continuous Professional Education, Clinical Municipal Children Hospital St. Vladimir
Russian Federation
Russian Federation
Nataliya A. Sholokhova – Dr. of Sci. (Med.), Professor, Department of Pediatric Radiology, Head, Department of Radiodiagnostics
Moscow
S. J.k. Hadiyeva
Russian University of Medicine, Russian Children’s Clinical Hospital — the separate structural unit of N. I. Pirogov Russian National Research Medical University
Russian Federation
Russian Federation
Sakina J. Hadiyeva – Postgraduate student, Radiology department, Federal State Budgetary Educational Institution of Higher Education, Radiologist, Radiological Center, Russian Children’s Clinical Hospital — the separate structural unit of the Federal State Autonomous Educational Institution of Higher Education
Moscow
N. I. Ponomareva
Russian Children’s Clinical Hospital — the separate structural unit of N. I. Pirogov Russian National Research Medical University
Russian Federation
Russian Federation
Natalia I. Ponomareva – Oncologist, Hematologist, Head, Department of Hematology and Chemotherapy № 2, unit of the Federal State Autonomous Educational Institution of Higher Education
117, Leninsky Prospekt, Moscow, 119571
M. V. Polyanskaya
Russian Children’s Clinical Hospital — the separate structural unit of N. I. Pirogov Russian National Research Medical University, N. I. Pirogov Russian National Research Medical University
Russian Federation
Russian Federation
Maiya V. Polyanskaya – Cand. of Sci. (Med.), Assistant, Department of Neurology, Neurosurgery, and Medical Genetics, Federal State Autonomous Educational Institution of Higher Education, Radiologist, Radiological Center
Moscow
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Review
For citations:
Sholokhova N.A., Hadiyeva S.J., Ponomareva N.I., Polyanskaya M.V. Methotrexate-induced stroke-like encephalopathy in children: а clinical case. Diagnostic radiology and radiotherapy. 2026;17(1):106-112. (In Russ.) https://doi.org/10.22328/2079-5343-2026-17-1-106-112
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