title: Acute Central Nervous System Complications in Pediatric Acute Lymphoblastic Leukemia.
abstract: BACKGROUND
  The outcome of childhood acute lymphoblastic leukemia has improved because of intensive chemotherapy and supportive care. The frequency of adverse events has also increased, but the data related to acute central nervous system complications during acute lymphoblastic leukemia treatment are sparse. The purpose of this study is to evaluate these complications and to determine their long term outcome.
  
  
  METHODS
  We retrospectively analyzed the hospital reports of 323 children with de novo acute lymphoblastic leukemia from a 13-year period for acute neurological complications. The central nervous system complications of leukemic involvement, peripheral neuropathy, and post-treatment late-onset encephalopathy, and neurocognitive defects were excluded.
  
  
  RESULTS
  Twenty-three of 323 children (7.1%) suffered from central nervous system complications during acute lymphoblastic leukemia treatment. The majority of these complications (n = 13/23; 56.5%) developed during the induction period. The complications included posterior reversible encephalopathy (n = 6), fungal abscess (n = 5), cerebrovascular lesions (n = 5), syndrome of inappropriate secretion of antidiuretic hormone (n = 4), and methotrexate encephalopathy (n = 3). Three of these 23 children (13%) died of central nervous system complications, one from an intracranial fungal abscess and the others from intracranial thrombosis. Seven of the survivors (n = 7/20; 35%) became epileptic and three of them had also developed mental and motor retardation.
  
  
  CONCLUSIONS
  Acute central neurological complications are varied and require an urgent approach for proper diagnosis and treatment. Collaboration among the hematologist, radiologist, neurologist, microbiologist, and neurosurgeon is essential to prevent fatal outcome and serious morbidity.
authors.affiliation: Department of Pediatric Hematology, Uludag University Medical Faculty, Bursa, Turkey. Electronic address: baytanbirol@yahoo.com.
authors.forename: Birol
authors.initials: B
authors.lastname: Baytan
authors.affiliation: Department of Pediatric Hematology, Uludag University Medical Faculty, Bursa, Turkey.
authors.forename: Melike Sezgin
authors.initials: MS
authors.lastname: Evim
authors.affiliation: Department of Pediatric Hematology, Uludag University Medical Faculty, Bursa, Turkey.
authors.forename: Salih
authors.initials: S
authors.lastname: Güler
authors.affiliation: Department of Pediatric Hematology, Uludag University Medical Faculty, Bursa, Turkey.
authors.forename: Adalet Meral
authors.initials: AM
authors.lastname: Güneş
authors.affiliation: Department of Pediatric Neurology, Uludag University Medical Faculty, Bursa, Turkey.
authors.forename: Mehmet
authors.initials: M
authors.lastname: Okan
mesh_terms: D001386:Azides; D001921:Brain / Q000473:pathology / Q000503:physiopathology; D002493:Central Nervous System Diseases / Q000150:complications* / Q000188:drug therapy / Q000473:pathology / Q000503:physiopathology; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D015282:Octreotide / Q000031:analogs & derivatives; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000150:complications* / Q000188:drug therapy / Q000473:pathology / Q000503:physiopathology; D012189:Retrospective Studies
chemical_list: D001386:Azides; C074329:EE 581; D015282:Octreotide
keywords: ALL-BFM protocols; abscess; acute central nervous system complications; acute lymphoblastic leukemia; cerebrovascular complications; children