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A Thrombotic Stroke Model Based On Transient Cerebral Hypoxia-ischemia
Published on: August 18, 2015
Transient ischemic cerebral lesions during induction chemotherapy for acute lymphoblastic leukemia
1Department of Child Neurology, Children's Hospital, University of Helsinki, Finland.
Insights
Nine children undergoing chemotherapy for leukemia or lymphoma experienced neurological symptoms like hallucinations and seizures. These stroke-like, but reversible, white matter lesions were linked to vascular ischemia.
Area of Science:
- Pediatric Oncology
- Pediatric Neurology
- Vascular Neurology
Background:
- Acute lymphoblastic leukemia and non-Hodgkin lymphoma are common childhood cancers.
- Induction chemotherapy is a critical phase in treating these hematologic malignancies.
- Neurological complications can arise during cancer treatment, impacting patient outcomes.
Purpose of the Study:
- To investigate neurological complications observed during induction chemotherapy in children with leukemia or lymphoma.
- To characterize the clinical presentation, neuroradiologic findings, and potential etiology of these neurological events.
Main Methods:
- Retrospective review of medical records for 90 children treated between 1986-1992.
- Detailed analysis of clinical symptoms, including visual hallucinations, confusion, seizures, constipation, and hypertension.
- Neuroradiologic examination (e.g., MRI, CT) to identify brain lesions.
Main Results:
- Nine children (10%) developed neurological symptoms during induction chemotherapy.
- Symptoms included visual hallucinations, confusion, and seizures, often preceded by constipation and hypertension.
- Neuroradiologic findings revealed bilateral cortical/subcortical white matter lesions, suggestive of vascular ischemia in arterial watershed areas. These lesions were reversible.
Conclusions:
- A subset of children undergoing chemotherapy for leukemia or lymphoma may experience reversible, stroke-like neurological complications.
- Vascular ischemia in the cerebral arterial watershed areas is a likely cause of these neurological manifestations.
- Prompt recognition and further investigation of these symptoms are crucial for managing pediatric cancer patients.
Abstract:
Ninety children were treated for acute lymphoblastic leukemia or non-Hodgkin lymphoma during 1986 through 1992 in the Children's Hospital, University of Helsinki, in Finland. During induction chemotherapy, nine of the children had visual hallucinations progressing to confusion and seizure. The symptoms were often preceded by severe constipation and significantly elevated blood pressure. Neuroradiologic examinations showed bilateral cortical or subcortical white matter lesions. Despite the stroke like manifestations, the lesions were reversible. The triangular shape and location of the lesions in the watershed areas between the major cerebral arteries suggest vascular ischemia as the cause.
