There are considerable variations in the reported incidence methotrexate-induced neurotoxicity in children with malignancies. The etiology of acute neurological deficit in pediatric patients with malignancies during polychemotherapy can be diverse: cerebrovascular disease (arterial ischemic stroke, intracranial hemorrhage, venous sinus thrombosis, or their combination), stroke-like migraine attacks after radiation therapy (SMART), posterior reversible encephalopathy syndrome (PRES), thrombotic microangiopathy, toxic leukoencephalopathy (include strokelike leukoencephalopathy). The tactics of a neurologist largely depends on the reasons that caused the neurological deficit. The doctor needs knowledge not only of the clinical picture and the characteristics of the course of the underlying disease, but also of possible complications arising both as a result of the disease itself and due to the therapy being carried out. Timely diagnosis and correct interpretation of emerging neurological events make it possible to determine rational accompanying therapy. The article presents case histories of children with acute lymphoblastic leukemias and acute neurological deficits, with an analysis of their possible causes.
There are considerable variations in the reported incidence of early and late epilepsy in children with lymphoproliferative diseases. The etiology of seizures in pediatric patients with hemoblastosis during polychemotherapy can be diverse: dysmetabolic, infectious, toxic, ischemic, posthemorrhagic. The treatment strategy selected by the neurologist largely depends on the causes of the paroxysmal conditions. When choosing the anti-seizure therapy one should consider the course of hemoblastoses and the possible effects of polychemotherapy. The article presents pediatric cases and the analysis of acute lymphoblastic leukemia with developing epileptic seizures.
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