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Reversible posterior leukoencephalopathy syndrome in children undergoing induction therapy for acute lymphoblastic
Jennifer K Norman1, Julie T Parke, Don A Wilson
1Department of Pediatrics, The University of Oklahoma Health Sciences Center Oklahoma City, Oklahoma, USA.
Insights
Three children developed reversible posterior leukoencephalopathy syndrome (RPLS) during acute lymphoblastic leukemia (ALL) chemotherapy. Prompt management of symptoms like seizures and hypertension led to full recovery.
Area of Science:
- Neurology
- Pediatric Oncology
- Chemotherapy Complications
Background:
- Acute lymphoblastic leukemia (ALL) induction chemotherapy can present complex challenges.
- Neurologic complications during ALL treatment require careful monitoring and timely intervention.
Observation:
- Three pediatric cases of acute neurologic changes during ALL induction chemotherapy were observed.
- These cases exhibited symptoms consistent with reversible posterior leukoencephalopathy syndrome (RPLS), including altered mental status, seizures, and visual disturbances.
- Magnetic resonance imaging revealed characteristic findings supporting the RPLS diagnosis.
Findings:
- Reversible posterior leukoencephalopathy syndrome (RPLS) is a spectrum of neurologic changes.
- Symptoms include headache, seizures, visual changes, and hypertension.
- Characteristic MRI findings aid in RPLS diagnosis.
Implications:
- Early identification and management of RPLS are crucial for pediatric patients undergoing ALL chemotherapy.
- Prompt treatment of hypertension, seizure control, and discontinuation of offending agents can reverse symptoms.
- Effective management strategies facilitate rapid recovery and return to baseline functioning in affected children.
Abstract:
We present three cases of children with acute neurologic changes while undergoing induction chemotherapy for acute lymphoblastic leukemia (ALL). These cases fall into the spectrum of reversible posterior leukoencephalopathy syndrome (RPLS), including abrupt alterations in mental status, headache, seizures, visual changes, hypertension, and characteristic findings on magnetic resonance imaging. Although the underlying mechanism of RPLS is still under investigation, the appropriate treatment and management of the acute event is becoming clearer. Early treatment of hypertension, control of seizure activity, and withdrawal of inciting agents can lead to rapid reversal of symptoms and return to baseline functioning.
