Asynchronous burst-suppression in a child with callosal Ki-1 anaplastic large cell lymphoma

Area of Science:

• Neuro-oncology
• Pediatric Neurology
• Radiation Oncology

Background:

• Ki-1 anaplastic large cell lymphoma (Ki-1ALCL) can present with central nervous system involvement.
• Cranial irradiation is a standard treatment for pediatric brain tumors, but can cause significant side effects.
• Raised intracranial pressure and altered mental status are serious complications in pediatric oncology.

Observation:

• A 13-year-old girl with bulky Ki-1ALCL brain deposits developed coma and elevated intracranial pressure.
• The patient exhibited asynchronous burst-suppression on electroencephalogram (EEG) after cranial irradiation.
• Clinical improvement was observed with supportive care, corticosteroids, and chemotherapy.

Findings:

• Asynchronous burst-suppression coma in this case was associated with radiation effects on the brain.
• The specific EEG pattern suggested lesions affecting cortical interconnections, potentially the corpus callosum.
• The patient's condition was reversible with multimodal treatment.

Implications:

• This case suggests that burst-suppression coma secondary to radiation effects in pediatric brain tumors may be reversible.
• EEG findings, particularly asynchronous burst-suppression, can help localize neurological damage in the context of CNS tumors and treatment.
• Understanding reversible causes of coma is crucial for optimizing management in pediatric neuro-oncology patients.