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Methotrexate (MTX) is an important cytostatic drug in cancer chemotherapy and the most widely used antimetabolite in childhood cancers. It is effective in the treatment of acute lymphoblastic leukemia (ALL), non-Hodgkin lymphoma, histiocytosis and osteosarcoma. Although its mechanism of action is not fully understood, it had been postulated as a cell cycle specific folate that inhibits dihydrofolate reductase achieving elevated levels of homocysteine and excitatory amino acid neurotransmitter metabolites. High dose MTX (HDMTX) is commonly used in the treatment of osteosarcoma.1 It can cause acute, subacute and chronic neurological complications. Stroke-like encephalopathy is a sub-acute MTX neurotoxicity and a rare syndrome that manifests with an abrupt onset of focal neurological deficits.2 It can cause hemiparesis, slurred speech, confusion,

Stroke-like encephalopathy following high-dose intravenous methotrexate in an adolescent with osteosarcoma: a case report