Abstract
We report on 2 patients who developed widespread cerebral vasospasm and arterial ischemic strokes (AIS) after application of intrathecal (IT) cytarabine. In a 3-year-old child with acute lymphoblastic leukemia (ALL), left leg weakness, hyperreflexia, and clonus were noted 4 days after her first dose of IT cytarabine during the induction phase of her chemotherapy. Cerebral MRI revealed multiple acute cerebral ischemic infarcts and widespread cerebral vasospasm. A 5-year-old girl complained of right arm and leg pain and began limping 11 days after IT cytarabine. Symptoms progressed to right dense hemiplegia, left gaze deviation, headache, and speech arrest. MRI revealed 2 large cortical areas of diffusion restriction in the right frontal and left parietal lobes. Cerebral magnetic resonance angiography (MRA) showed irregular narrowing affecting much of the intracranial arterial circulation. Although the first child fully recovered from her neurologic symptoms, the second patient had persistent hemiplegia on follow-up. Including this report, there are now 4 pediatric ALL cases of severe cerebral vasospasm and AIS in the context of IT cytarabine administration, strongly suggesting a true association. Differential diagnosis and manag...Continue Reading
References
Apr 11, 1991·Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology·W J BakerR B Weiss
Nov 24, 1999·Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology·P VéraE Vilmer
Jan 29, 2003·Neurology·R D HendersonS J Read
Dec 25, 2003·Thrombosis Research·Uma H Athale, Anthony K C Chan
Mar 16, 2007·Journal of Pediatric Hematology/oncology·Catherine M PoundDonna L Johnston
Jul 19, 2008·Stroke; a Journal of Cerebral Circulation·E Steve RoachUNKNOWN Council on Cardiovascular Disease in the Young
Jun 24, 2011·Journal of Magnetic Resonance Imaging : JMRI·Ye QiaoBruce A Wasserman
Dec 14, 2011·Blood·Tal SchechterLeonardo R Brandão
May 15, 2012·Critical Reviews in Oncology/hematology·Jose Manuel VagaceGuillermo Gervasini
Sep 22, 2012·Lancet Neurology·Anne Ducros
Oct 27, 2012·Leukemia·E TrueloveB J Hunt
May 15, 2013·Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology·Gary H LymanUNKNOWN American Society of Clinical Oncology Clinical Practice
Apr 12, 2014·AJNR. American Journal of Neuroradiology·E C ObusezS E Jones
Dec 19, 2014·Pediatrics International : Official Journal of the Japan Pediatric Society·Jong Hyung YoonByung-Kiu Park
Citations
Oct 23, 2016·The Journal of Pediatrics·Takahiro AokiRyoji Hanada
Jan 15, 2020·Cancer Metastasis Reviews·Caren Armstrong, Lisa R Sun
Mar 14, 2019·International Journal of Hematology·Ting-An LinJin-Hwang Liu
Jun 17, 2020·Pediatric Research·Lisa R SunRyan J Felling
Jan 16, 2021·Pediatric Research·Lisa R Sun
Oct 7, 2021·Topics in Magnetic Resonance Imaging : TMRI·Sarah LeeTodd A Abruzzo
Jan 17, 2019·Pediatric Neurosurgery·Belinda ShaoRichard C E Anderson