Use Chemotherapy-Associated Neurotoxicity for Practical Clinical Decision-Making to guide the working diagnosis and next step; let the main risk or management issue drive escalation, treatment choice, and follow-up.

We classify high-dose methotrexate as any dose exceeding 500 milligrams per meter squared.; Acutely or subacutely, it can cause severe neurotoxic events, including sudden focal deficits, profound encephalopathy, and seizures.; Run routine, ongoing complete blood counts, liver function tests, and close renal function monitoring.; Chronic, persistent microglial activation has been clearly documented following exposure to methotrexate, carboplatin, and cisplatin, serving as a primary driver for long-term neuroinflammation and cognitive decline.; Management centers on the immediate withdrawal of the drug alongside comprehensive, intensive supportive care.