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Brain White Matter Changes during Treatment of a Child for Acute Lymphoblastic Leukemia

Miho Maeda¹, Jun Hayakawa¹, Takahiro Ueda¹, Makoto Migita¹, Takeshi Asano¹, Yoshitaka Fukunaga¹ and Yasuo Amano²

¹Department of Pediatrics, Nippon Medical School
²Department of Radiology, Nippon Medical School

A 13-year old boy with acute lymphoblastic leukemia had bilateral paresis of the upper extremities and aphasia 1 week after high dose methotrexate and triple intrathecal therapy (methotrexate, cytarabin, hydrocortisone). The stroke-like neurological symptoms disappeared on the third day. T2-weighted magnetic resonance imaging showed hyperintensities of white matter on the second day. Despite resolution of the neurological symptoms, magnetic resonance images were still abnormal 3 years after the attack.
Methotrexate has been considered to be responsible for ischemic damage to oligodendroglial cells, resulting in demyelination. The changes are occasionally prolonged without persistent neurologic symptoms.

J Nippon Med Sch 2005; 72: 252-253

Correspondence to
Miho Maeda, Department of Pediatrics, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan
maeda@nms.ac.jp