Severe Cerebral Vasospasm and Childhood Arterial Ischemic Stroke After Intrathecal Cytarabine

被引:16
|
作者
Tibussek, Daniel [1 ,2 ]
Natesirinilkul, Rungrote [3 ]
Sun, Lisa R. [4 ]
Wasserman, Bruce A. [5 ]
Brandao, Leonardo R. [3 ]
deVeber, Gabrielle [1 ]
机构
[1] Hosp Sick Children, Dept Pediat, Div Neurol, Toronto, ON M5G 1X8, Canada
[2] Univ Dusseldorf, Dept Gen Pediat Neonatol & Pediat Cardiol, Univ Childrens Hosp, Moorenstr 5, D-40225 Dusseldorf, Germany
[3] Hosp Sick Children, Dept Pediat, Div Hematol & Oncol, Toronto, ON M5G 1X8, Canada
[4] Johns Hopkins Univ Hosp, Div Pediat Neurol, Dept Neurol, Baltimore, MD 21287 USA
[5] Johns Hopkins Med Inst, Russell H Morgan Dept Radiol & Radiol Sci, 600 N Wolfe St, Baltimore, MD 21205 USA
关键词
ACUTE LYMPHOBLASTIC-LEUKEMIA; VASOCONSTRICTION SYNDROME; CHILDREN; CHEMOTHERAPY; ASPARAGINASE; TOXICITY; THERAPY; DISEASE; MRI;
D O I
10.1542/peds.2015-2143
中图分类号
R72 [儿科学];
学科分类号
100202 ;
摘要
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 management issues are discussed. Along with the more widespread use of MRI and MRA, the true frequency of this severe adverse effect will become clearer in future. For any child with neurologic symptoms within hours or days of receiving IT cytarabine, a low threshold for cerebral imaging with MRI and MRA is recommended.
引用
收藏
页数:5
相关论文
共 50 条
  • [1] Diffuse cerebral vasospasm with infarct after intrathecal cytarabine in childhood leukemia
    Yoon, Jong Hyung
    Yoon, Ju Young
    Park, Hyeon Jin
    Son, Meong Hi
    Kim, Su-Hyun
    Kim, Woojun
    Kim, Ho Jin
    Lee, Sang Hyun
    Park, Byung-Kiu
    PEDIATRICS INTERNATIONAL, 2014, 56 (06) : 921 - 924
  • [2] Diffuse cerebral vasospasm with infarct after intrathecal cytarabine in childhood leukemia (vol 56, pg 921, 2014)
    Yoon, Jong Hyung
    Yoon, Ju Young
    Park, Hyeon Jin
    Son, Meong Hi
    Kim, Su-Hyun
    Kim, Woojun
    Kim, Ho Jin
    Lee, Sang Hyun
    Park, Byung-Kiu
    PEDIATRICS INTERNATIONAL, 2015, 57 (06) : 1218 - 1218
  • [3] Evolution of cerebral arteriopathies in childhood arterial ischemic stroke
    Danchaivijitr, N
    Cox, TC
    Saunders, DE
    Ganesan, V
    ANNALS OF NEUROLOGY, 2006, 59 (04) : 620 - 626
  • [4] Evolution of cerebral arteriopathies in childhood arterial ischemic stroke
    Danchaivijitr, N
    Cox, TC
    Saunders, DE
    Ganesan, V
    STROKE, 2006, 37 (02) : 696 - 696
  • [5] Evolution Of Cerebral Diaschisis In Childhood Arterial Ischemic Stroke
    Kirton, Adam
    Williams, Elizabeth
    Dowling, Michael
    Ichord, Rebecca
    STROKE, 2013, 44 (02)
  • [6] Diffusion imaging of cerebral diaschisis in childhood arterial ischemic stroke
    Kirton, Adam
    Williams, Elizabeth
    Dowling, Michael
    Mah, Sarah
    Hodge, Jacquie
    Carlson, Helen
    Wei, Xing-Chang
    Ichord, Rebecca
    INTERNATIONAL JOURNAL OF STROKE, 2016, 11 (09) : 1028 - 1035
  • [7] Psychological Outcomes After Childhood Arterial Ischemic Stroke
    Maxwell, Emily C.
    Ballantyne, Tonia
    Carlson, Kathleen E.
    Hollatz, Amanda L.
    Clevenger, K. C.
    Armstrong-Wells, Jennifer
    Bernard, Timothy J.
    Boada, Richard
    STROKE, 2017, 48
  • [8] Cerebral palsy after perinatal arterial ischemic stroke
    Golomb, Meredith R.
    Garg, Bhuwan P.
    Saha, Chandan
    Azzouz, Faouzi
    Williams, Linda S.
    JOURNAL OF CHILD NEUROLOGY, 2008, 23 (03) : 279 - 286
  • [9] Cerebral palsy after perinatal arterial ischemic stroke
    Golomb, Meredith R.
    Garg, Bhuwan P.
    Saha, Chandan
    Azzouz, Faouzi
    Williams, Linda S.
    ANNALS OF NEUROLOGY, 2007, 62 : S104 - S104
  • [10] Stroke Associated with Severe Cerebral Vasospasm after Petroclival Meningioma Resection
    Chmayssani, Mohamad
    Murthy, Santosh
    Ghosh, Subrata
    Bershad, Eric
    Suarez, Jose
    NEUROLOGY, 2012, 78