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Ventral polyradiculopathy with pediatric acute lymphocytic leukemia
Stephen C Anderson1, George D Baquis, Anthony Jackson
1Department of Medicine, Baystate Medical Center, Springfield, Massachusetts, USA. sanderso@massmed.org
Muscle & Nerve
|December 26, 2001
Summary
A child treated for acute lymphocytic leukemia (ALL) developed nerve damage after chemotherapy. Findings suggest chemotherapy may selectively harm ventral nerve roots, aiding early diagnosis.
Area of Science:
- Neuroscience
- Pediatric Oncology
- Neuromuscular Disorders
Background:
- Intrathecal chemotherapy, including methotrexate, cytarabine, and hydrocortisone, is a standard treatment for acute lymphocytic leukemia (ALL).
- Neurological complications can arise from chemotherapy, necessitating careful monitoring and differential diagnosis.
Observation:
- A 3-year-old girl with ALL in remission presented with lower extremity paraparesis and areflexia 15 days post-intrathecal chemotherapy.
- Cerebrospinal fluid analysis revealed elevated protein (107 mg/dl).
- Nerve conduction studies showed reduced compound muscle action potential amplitudes and absent F waves, with normal sensory conduction.
Findings:
- Needle electromyography (EMG) indicated reduced motor unit potential recruitment.
- Magnetic resonance imaging (MRI) revealed lumbosacral ventral root enhancement.
- The patient showed slow recovery following treatment with intravenous immunoglobulin.
Implications:
- The correlation between electrodiagnostic abnormalities and MRI findings suggests selective ventral nerve root vulnerability to intrathecal chemotherapy.
- This pattern aids in distinguishing chemotherapy-induced nerve damage from myelopathy or distal polyneuropathy.
- Findings support early diagnosis and targeted treatment, while also considering a potential autoimmune component.