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A case of treatment-related leukoencephalopathy: sequential MRI, CT and PET findings
1Department of Neurosurgery, Faculty of Medicine, Kyoto University, Japan.
Abstract:
A case of treatment-related leukoencephalopathy is presented. A patient with medulloblastoma was postoperatively treated with craniospinal axis irradiation. One month after irradiation, weekly intrathecal administration of methotrexate was performed 4 times to treat cerebrospinal fluid dissemination of the tumor. Two months after the initiation of intrathecal chemotherapy, the patient became somnolent and developed decerebrate posturing. Magnetic resonance imaging showed diffuse leukoencephalopathy. Positron emission tomography revealed a diffuse decrease in glucose uptake in the deep white matter. Auditory evoked potential also showed diffuse abnormalities, not only in the cerebrum, but also in the brain stem. High dose intravenous leucovorin rescue was attempted without any neurologic improvement.
Insights
Treatment-related leukoencephalopathy occurred in a medulloblastoma patient after craniospinal irradiation and intrathecal methotrexate. Despite leucovorin rescue, severe neurological deficits persisted, highlighting potential treatment toxicities.
Area of Science:
- Neuro-oncology
- Radiation Oncology
- Neurotoxicity
Background:
- Medulloblastoma treatment often involves craniospinal irradiation and chemotherapy.
- Intrathecal methotrexate is used to prevent or treat cerebrospinal fluid dissemination.
- Treatment-related complications, such as leukoencephalopathy, require careful monitoring.
Observation:
- A patient with medulloblastoma developed somnolence and decerebrate posturing post-treatment.
- Magnetic resonance imaging revealed diffuse leukoencephalopathy.
- Positron emission tomography and auditory evoked potentials indicated widespread central nervous system dysfunction.
Findings:
- The patient exhibited severe neurological decline following craniospinal irradiation and intrathecal methotrexate.
- Imaging and electrophysiological studies confirmed diffuse leukoencephalopathy and brainstem abnormalities.
- High-dose leucovorin rescue did not reverse the observed neurological deficits.
Implications:
- This case underscores the potential for severe neurotoxicity from combined radiation and intrathecal chemotherapy in medulloblastoma patients.
- It highlights the importance of recognizing and managing treatment-related leukoencephalopathy.
- Further research into neuroprotective strategies may be warranted for patients undergoing similar treatments.