Acute encephalopathy and cerebral vasospasm after multiagent chemotherapy including PEG-asparaginase and intrathecal cytarabine for the treatment of acute lymphoblastic leukemia.
A 7-year-old girl with an unusual reaction to induction chemotherapy for precursor B-cell acute lymphoblastic leukemia (ALL) is described. The patient developed acute encephalopathy evidenced by behavioral changes, aphasia, incontinence, visual hallucinations, and right-sided weakness with diffuse cerebral vasospasm on magnetic resonance angiography after the administration of intrathecal cytarabine. Vincristine, dexamethasone, and polyethylene glycol-asparaginase were also administered before the episode as part of induction therapy. Neurologic status returned to baseline within 10 days of the acute event, and magnetic resonance angiography findings returned to normal 4 months later.
Pound
Catherine M
CM
Department of Hematology/Oncology, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada. cpound@cheo.on.ca
Keene
Daniel L
DL
Udjus
Kristin
K
Humphreys
Peter
P
Johnston
Donna L
DL
D000208:Acute Disease; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects* / Q000627:therapeutic use; D001215:Asparaginase / Q000008:administration & dosage / Q000009:adverse effects*; D001921:Brain / Q000473:pathology; D001927:Brain Diseases / Q000139:chemically induced* / Q000473:pathology; D002051:Burkitt Lymphoma / Q000188:drug therapy*; D002648:Child; D003561:Cytarabine / Q000008:administration & dosage / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007278:Injections, Spinal; D018810:Magnetic Resonance Angiography / Q000379:methods; D011092:Polyethylene Glycols / Q000008:administration & dosage / Q000009:adverse effects*; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000188:drug therapy*; D012680:Sensitivity and Specificity; D016896:Treatment Outcome; D020301:Vasospasm, Intracranial / Q000139:chemically induced* / Q000473:pathology
D003561:Cytarabine; D011092:Polyethylene Glycols; C042705:pegaspargase; D001215:Asparaginase