Brain white matter changes during treatment of a child for acute lymphoblastic leukemia.
A 13-year old boy with acute lymphoblastic leukemia had bilateral paresis of the upper extremities and aphasia 1 week after high dose methotrexate and triple intrathecal therapy (methotrexate, cytarabin, hydrocortisone). The stroke-like neurological symptoms disappeared on the third day. T2-weighted magnetic resonance imaging showed hyperintensities of white matter on the second day. Despite resolution of the neurological symptoms, magnetic resonance images were still abnormal 3 years after the attack. Methotrexate has been considered to be responsible for ischemic damage to oligodendroglial cells, resulting in demyelination. The changes are occasionally prolonged without persistent neurologic symptoms.
Maeda
Miho
M
Department of Pediatrics, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan. maeda@nms.ac.jp
Hayakawa
Jun
J
Ueda
Takahiro
T
Migita
Makoto
M
Asano
Takeshi
T
Fukunaga
Yoshitaka
Y
Amano
Yasuo
Y
D000293:Adolescent; D000964:Antimetabolites, Antineoplastic / Q000009:adverse effects*; D001921:Brain / Q000473:pathology*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008727:Methotrexate / Q000009:adverse effects*; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000188:drug therapy* / Q000473:pathology*
D000964:Antimetabolites, Antineoplastic; D008727:Methotrexate