We propose the use of the term 'acute hyperextension myelopathy' to categorize patients with spinal cord infarction secondary to hyperextension. DWI sequencing on MRI should be considered to evaluate for early signs of spinal cord ischemia in these patients. Use of a broader term for diagnostic classification can help include patients with spinal cord infarction due to a common mechanism.
Continuous infusion valproic acid appears to be a safe, effective, and predictable manner by which to administer valproic acid to pediatric and adult patients admitted to the hospital.
An 11-year-old boy had a relapse of acute lymphoblastic leukemia involving the CNS. He was treated with whole brain radiotherapy and intrathecal methotrexate. One week after the whole brain radiotherapy, he developed personality changes and right facial weakness. Brain MRI was obtained (Figure 1). Disseminated necrotizing leukoencephalopathy is an uncommon neurotoxicity syndrome associated with whole brain radiotherapy and methotrexate. Personality change is commonly reported 1. Disseminated necrotizing leukoencephalopathy is characterized by subcortical T2-hyperintensities with low-signal foci and corresponding contrast-enhancing areas 1,2. Early cessation of inciting therapies may prevent progression (Figure 2). Our patient returned to his neurologic baseline and at 14-month follow-up remained without further deterioration.
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