Reversible posterior leukoencephalopathy syndrome in children undergoing induction therapy for acute lymphoblastic leukemia.
We present three cases of children with acute neurologic changes while undergoing induction chemotherapy for acute lymphoblastic leukemia (ALL). These cases fall into the spectrum of reversible posterior leukoencephalopathy syndrome (RPLS), including abrupt alterations in mental status, headache, seizures, visual changes, hypertension, and characteristic findings on magnetic resonance imaging. Although the underlying mechanism of RPLS is still under investigation, the appropriate treatment and management of the acute event is becoming clearer. Early treatment of hypertension, control of seizure activity, and withdrawal of inciting agents can lead to rapid reversal of symptoms and return to baseline functioning.
Norman
Jennifer K
JK
Department of Pediatrics, The University of Oklahoma Health Sciences Center Oklahoma City, Oklahoma, USA.
Parke
Julie T
JT
Wilson
Don A
DA
McNall-Knapp
René Y
RY
D000293:Adolescent; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects*; D001812:Blood-Brain Barrier; D001929:Brain Edema / Q000139:chemically induced* / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology; D002648:Child; D002675:Child, Preschool; D013181:Cortical Spreading Depression; D003711:Demyelinating Diseases / Q000139:chemically induced* / Q000150:complications / Q000000981:diagnostic imaging / Q000473:pathology; D038524:Diffusion Magnetic Resonance Imaging; D005260:Female; D005911:Gliosis / Q000209:etiology; D006261:Headache / Q000209:etiology; D006801:Humans; D006973:Hypertension / Q000209:etiology; D015459:Leukemia-Lymphoma, Adult T-Cell / Q000188:drug therapy*; D008297:Male; D009778:Occipital Lobe / Q000098:blood supply / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology; D010296:Parietal Lobe / Q000098:blood supply / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology; D015452:Precursor B-Cell Lymphoblastic Leukemia-Lymphoma / Q000188:drug therapy*; D012074:Remission Induction; D012640:Seizures / Q000209:etiology; D013577:Syndrome; D014057:Tomography, X-Ray Computed; D014715:Vertebrobasilar Insufficiency / Q000209:etiology; D014786:Vision Disorders / Q000209:etiology