The treatment and prophylactic therapy of meningeal leukemia with intrathecal methotrexate in acute lymphoblastic leukemia is the standard method. Intrathecal overdose of methotrexate may produce severe toxicities such as paraplegia. We experienced a case of paraplegia diagnosed by magnetic imaging examination of the spine in a 24-year-old woman received repeated intrathecal methotrexate for meningeal leukemia. (J Korean Acad Rehab Med 2006; 30: 188- 190)