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Updated: Jun 21, 2026
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Published on: July 4, 2007
Regression of chronic posterior leukoencephalopathy after stop of methotrexate treatment
Gabriella Marcon1, Anna Rita Giovagnoli, Paola Mangiapane
1Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, 20133, Milan, Italy. gmarcon@istituto-besta.it
Abstract:
Posterior reversible leukoencephalopathy (PRLE) is a neurological disorder caused by a variety of pathological conditions such as high doses or long-term low-doses of immunosuppressive therapy. PRLE associated with methotrexate (MTX) is well known but it was rarely observed in adult patients submitted to long-term low-dose administration via the oral route. Here we report the case of a patient affected by psoriasis, treated by chronic oral low-dose of MTX, who presented with limb ideomotor apraxia. Magnetic resonance (MRI) of the brain showed, on T2-weighted images, a diffuse hyperintensity involving bilaterally the white matter of the occipital, parietal and frontal lobes. MTX treatment was stopped and, at the 6-month follow-up, the neuropsychological performances was improved. Two years later, the neuropsychological profile was normal and MRI showed a regression of the white matter abnormalities.
Insights
Posterior reversible encephalopathy (PRLE) can occur with long-term, low-dose methotrexate (MTX) therapy. This case highlights PRLE presenting as ideomotor apraxia in an adult psoriasis patient, with neurological and MRI improvements after MTX cessation.
Area of Science:
- Neurology
- Radiology
- Pharmacology
Background:
- Posterior reversible leukoencephalopathy (PRLE) is a neurological disorder linked to various conditions, including immunosuppressive therapies.
- Methotrexate (MTX)-associated PRLE is documented, but rare in adults on long-term, low-dose oral administration.
Observation:
- A psoriasis patient on chronic oral low-dose MTX developed limb ideomotor apraxia.
- Brain MRI revealed diffuse white matter hyperintensities in occipital, parietal, and frontal lobes on T2-weighted images.
Findings:
- MTX treatment cessation led to improved neuropsychological performance at 6-month follow-up.
- Two-year follow-up showed a normal neuropsychological profile and regression of white matter abnormalities on MRI.
Implications:
- This case underscores the potential for PRLE in adult patients receiving long-term, low-dose oral MTX.
- Early recognition and MTX withdrawal are crucial for favorable neurological recovery and MRI resolution.
