A case of treatment-related leukoencephalopathy: sequential MRI, CT and PET findings.
A case of treatment-related leukoencephalopathy is presented. A patient with medulloblastoma was postoperatively treated with craniospinal axis irradiation. One month after irradiation, weekly intrathecal administration of methotrexate was performed 4 times to treat cerebrospinal fluid dissemination of the tumor. Two months after the initiation of intrathecal chemotherapy, the patient became somnolent and developed decerebrate posturing. Magnetic resonance imaging showed diffuse leukoencephalopathy. Positron emission tomography revealed a diffuse decrease in glucose uptake in the deep white matter. Auditory evoked potential also showed diffuse abnormalities, not only in the cerebrum, but also in the brain stem. High dose intravenous leucovorin rescue was attempted without any neurologic improvement.
Miyatake
S
S
Department of Neurosurgery, Faculty of Medicine, Kyoto University, Japan.
Kikuchi
H
H
Oda
Y
Y
Ishikawa
M
M
Kojima
M
M
Matsubayashi
K
K
Minamikawa
J
J
Yamagata
S
S
Asato
R
R
D001798:Blood Proteins / Q000032:analysis; D001925:Brain Damage, Chronic / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology* / Q000473:pathology; D001927:Brain Diseases / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology* / Q000473:pathology; D002528:Cerebellar Neoplasms / Q000188:drug therapy / Q000532:radiotherapy / Q000601:surgery / Q000628:therapy*; D002556:Cerebrospinal Fluid Proteins / Q000032:analysis; D002557:Cerebrospinal Fluid Shunts; D002648:Child; D003131:Combined Modality Therapy / Q000009:adverse effects; D016371:Cranial Irradiation / Q000009:adverse effects*; D003655:Decerebrate State / Q000209:etiology; D003952:Diagnostic Imaging; D005260:Female; D006801:Humans; D007278:Injections, Spinal; D002955:Leucovorin / Q000627:therapeutic use; D008279:Magnetic Resonance Imaging; D008527:Medulloblastoma / Q000188:drug therapy / Q000532:radiotherapy / Q000601:surgery / Q000628:therapy*; D008727:Methotrexate / Q000008:administration & dosage / Q000009:adverse effects*; D011832:Radiation Injuries / Q000209:etiology*; D014055:Tomography, Emission-Computed; D014057:Tomography, X-Ray Computed
D001798:Blood Proteins; D002556:Cerebrospinal Fluid Proteins; D002955:Leucovorin; D008727:Methotrexate