Transient posterior encephalopathy induced by chemotherapy in children
Sánchez-Carpintero R [SP], Narbona J, López de Mesa R [SP], Arbizu J [SP], Sierrasesúmaga L.
Pediatric Neurology Unit, Department of Pediatrics, University Clinic of Navarra and School of Medicine, University of Navarra, Pamplona, Spain.
Magazine: Pediatric Neurology
Date: Feb 1, 2001Nuclear Medicine [SP] Pediatric Neurology Unit [SP] Pediatrics [SP]
The cases of three children, 16, 12, and 12 years of age, who suffered sudden confusional state and cortical blindness lasting 12 to 30 minutes while under treatment with high-dose methotrexate, cyclophosphamide, and dactinomycin for a lower limb osteosarcoma are reported.
Transient neuropsychologic deficits arose after the acute phase of treatment: left hemispatial neglect and constructive apraxia (Patient 1); constructive apraxia (Patient 2); and constructive apraxia and alexia without aphasia (Patient 3). The three patients recovered completely from all their deficits within the time frame of 3 hours to 2 weeks. Arterial hypertension and hypomagnesemia were found during the acute phase in all patients. In Patients 2 and 3, magnetic resonance imaging revealed increased parieto-occipital T(2) signal involving gray and white matter. In Patients 1 and 2, HmPAO-SPECT revealed parieto-occipital hypoperfusion that resolved a few days later.
The alterations detected by neuroimaging were concurrent with the appearance and disappearance of the clinical symptoms. Such transient acute episodes have been named occipital-parietal encephalopathy.
On the basis of our clinical, laboratory, and neuroimaging findings, an explanation for the origin of this syndrome, a migrainelike mechanism, triggered by chemotherapy-induced hypomagnesemia, is proposed.
CITATION Pediatr Neurol. 2001 Feb;24(2):145-8
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