Coexistence of Life Threatening Chemotherapy Related Leukoencephalopathy, Saggital Sinus Thrombosis and Multiple Organ Failure in a Child with Acute Lymphoblastic Leukemia: An Unusual Case with Clinical Recovery (original) (raw)
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Journal of the Chinese Medical Association, 2011
We report the case of a 4-year-old boy with acute lymphoblastic leukemia in high-risk group who suffered from generalized tonic-colonic seizure evolving into status epilepticus, and subsequent left hemiparesis during his first reinduction chemotherapy, consisting of dexamethasone, vincristine, L-asparaginase, and epirubicin. Superior sagittal sinus and cerebral venous thrombosis, predominantly in right side, were proved by brain magnetic resonance imaging. After aggressive treatment with low-molecular weight heparin (LMWH), left hemiparesis improved in 1 week. And he was fully ambulatory 3 weeks later. The second cycle of reinduction chemotherapy was conducted smoothly with the concomitant use of LMWH. This case illustrates the strong correlation of the rare thrombotic complication, superior sagittal sinus thrombosis, and hypercoagulable status secondary to combination use of L-asparaginase and corticosteroid. Early and vigilant recognition of superior sagittal sinus thrombosis and prompt anticoagulation with LMWH may prevent further neurological damage.
Neuropediatrics, 2008
each QOD × 6 (Mah-OPI, Thissen, France). Her consolidation consisted of high dose methotrexate for four cycles. After the fi rst week of maintenance which consisted of dexamethasone 12 mg / m 2 , and L -asparginase 25 000 units / m 2 she developed generalized clonic jerks with up rolling of eyes and drooling of saliva, bladder incontinence and loss of consciousness that lasted for 30 minutes. This was preceded by headache the night before but without a change in the behaviour or altered consciousness. The blood pressure was normal during the clinical episode of seizure. She responded to valium and phenytoin. Her platelet count was normal and a non-enhanced CT of brain was negative for bleeding. Brain MRI done on the same day as the development of the clinical symptoms revealed multiple cortical and subcortical abnormal high signal intensity lesions seen on T 2 and fl uid attenuated inversion recovery (FLAIR) weighted images ( ᭹ ). The lesions were most pronounced in the parietal lobes bilaterally and to a lesser extent in the occipital, frontal and temporal lobes bilaterally. A similar lesion was seen in the left cerebellum. These lesions did not show abnormal signal on the diffusion-weighted images or restricted ADC to suggest an acute infarct ( ᭹ ᭤ . Post gadolinium administration, these lesions show no enhancement ( ᭹ ᭤ ). MR venography was performed and demonstrated no venous sinus Abstract &
2018
Acute Lymphoblastic Leukemia (ALL) is the most common malignancy in children. Prednisone, Vincristine, Cytarabine and also L-Asparaginase are usually used in induction chemotherapy. Thrombovascular events such as Cerebral Sinovenous Thrombosis (CSVT) are one of the most common complications of the disease that may arise during or even after the treatment. Majority of the cases of CSVT are either directly attributed to ALL or considered as a consequence of using chemotherapy agents mentioned above. In this manuscript we present an 8-years-old boy diagnosed with ALL who exhibited seizure attack following his first chemotherapy cession. CSVT was finally diagnosed due to manifestations and assessments.
Indian Journal of Medical and Paediatric Oncology, 2020
Background: Cerebral sinus venous Thrombosis (CSVT) is a rare complication of acute lymphoblastic leukemia (ALL) treatment, with an incidence rate ranging from 1.1% to 2.9%. Steroids and L-asparaginase (LASP) are the major risk factors. Methods: The aim of this study was to find the incidence rate and risk factors for CSVT in our patients. Ninety-two pediatric ALL diagnosed and treated with ALL-Berlin–Frankfurt–Munster-95 protocol over a period of 5 years (2013–2017) were the subject of the study. Six (6.5%) patients developed CSVT during their therapy and were further analyzed. Results: Six (five males and one female) patients had a CSVT event. The mean age at presentation was 13.5 ± 4.1 years. CSVT event occurred during the induction/re-induction phase of chemotherapy. The superior sagittal sinus was the most frequent site of thrombosis. The timing of CSVT was related to using of LASP and steroids. High-risk disease was associated with an increased risk of thrombosis. Infection an...
L-asparaginase induced fatal cortical venous thrombosis in acute lymphoblastic leukemia
Indian Journal of Hematology and Blood Transfusion, 2010
L-asparaginase has become an integral part in the treatment of acute lymphoblastic leukemia. The major worry of using L-asparaginase is thromboembolism. The case presented here is a 21-year-old lady who developed fatal cortical venous thrombosis during induction phase of treatment for ALL. Early recognition is very important to treat this potentially catastrophic yet treatable complication.
Cerebral Sinus Venous Thrombosis due to Asparaginase Therapy
Case Reports in Hematology, 2013
We report a 9-year-old boy with acute lymphoblastic leukemia (ALL) in high-risk group who suffered from left sided focal seizures and ipsilateral hemiparesis during his induction with Asparaginase chemotherapy. Superior sagittal sinus thrombosis and right frontal hemorrhage were demonstrated on brain magnetic resonance imaging (MRI) scans . Anticoagulation was initiated with unfractionated heparin and switched to low molecular weight heparin after 3 weeks and continued for 6 months. At one-year followup, he had complete response to chemotherapy for ALL, with residual mild left hemiparesis, and his MRI scans revealed recanalized venous sinuses. The case highlights the importance of considering cerebral venous thrombosis as a complication of Asparaginase therapy.
Modern Pathology, 2004
We have observed an increasing number of autopsies on patients with chemotherapy-related complications. One complication is toxic leukoencephalopathy, which is due to a direct toxic effect of chemotherapeutic agents on the central nervous system white matter. Autopsies of four cases of toxic leukoencephalopathy were performed following standard protocols. The brain and spinal cord were examined routinely, and histological sections were taken for evaluation. We report here three patients with hematologic malignancies and one patient with metastatic carcinoma with chemotherapy-induced leukoencephalopathy. The first was a 56-yearold male treated with multiple chemotherapeutics for multiple myeloma. He presented with confusion and focal seizures with a rapid progression to coma and decerebrate posturing. The second was a 36-year-old male who developed mental status changes, ataxia and dysarthria following treatment for lymphoma. The third was a 16year-old male who developed a profound peripheral and central neuropathy after chemotherapy treatment for Tcell acute lymphoblastic leukemia. The fourth was a 49-year-old female patient who was treated with multiple chemotherapeutics for Stage II breast carcinoma and subsequently developed visual acuity and field defects. The neuropathologic findings in these cases, although similar, varied in severity and distribution. The white matter was affected by severe myelin pallor, edema, and a prominent macrophage infiltrate in each of the cases. The location and extent of the central nervous system pathology correlated with the type and severity of clinical symptoms. These four cases, with their varied presenting symptoms, clinical courses, and degree of pathology, emphasize the importance of considering toxic leukoencephalopathy as an etiology of acute neurologic deterioration following high-dose chemotherapy.
Cerebral Venous Sinus Thrombosis in Pediatric Cancer Patients
Journal of Pediatric Hematology/Oncology, 2013
Cerebral venous sinus thrombosis (CVST) is an uncommon but recognized complication of treatment for leukemia. Our goal was to determine the long-term neurocognitive outcomes in childhood cancer survivors who had CVST during therapy. Nine patients were identified from an institutional database. All had experienced CVST in the setting of L-asparaginase therapy in combination with other chemotherapeutic agents. Four patients completed neuropsychological evaluation. Their neurological examinations were normal. Neuropsychological testing showed that the participants performed well, with average to above-average scores on cognitive and behavioral testing. Three exhibited difficulties on a visual-motor integration task and 1 had difficulty with fine-motor dexterity, nonverbal memory, emotional control, shifting attention, and anxiety. Overall, by patient and parent report, the survivors had few problems. CVST is a known complication associated with treatment for leukemia and non-Hodgkin lymphoma, most commonly observed if asparaginase is used in combination with other chemotherapeutic agents. Although subtle difficulties were noted in survivors on neuropsychological testing, survivors themselves were not aware of the deficits. Further evaluation of leukemia survivors with a history of CVST is needed to assess for deficits and to understand whether further intervention is necessary.