Brain MR imaging abnormalities in pediatric patients after allogeneic bone marrow transplantation

Abstract

Objective: Our aim was to analyze brain MRI findings in pediatric patients who developed neurologic complications after allogeneic bone marrow transplantation. Materials and methods: This prospective study included 33 consecutive patients (age range from 3 to 18 years, mean 11.8 ± 5.1 years). They were referred to the MRI unit because of the neurological symptoms in the post transplant period. The underlying disorders included: non malignant hematological disorders (n = 20, 60.6%) and hematological malignancies (n = 13, 39.4%). Onset of the presentation of the complication in relation to the chronology of the transplant was identified in each patient (phase1: from days 0 to 30, phase 2: from days 30 to 100, and late phase after day 100). Results: According to the MRI findings 6 patients (18.2%) showed normal examinations. Twentyseven patients (81.8%) with positive MRI findings, are grouped into 7 main categories: posterior reversible encephalopathy syndrome (n = 16, 48.48%), intracranial hemorrhage (n = 2, 6.06%), cerebral venous sinus thrombosis (n = 1, 3.03%), CNS infection (n = 2, 6.06%), leukoencephalopathy (n = 5, 15.15%), mild atrophy (n = 11, 33.33%), CNS relapse (n = 1, 3.03%), with 9 patients having more than one diagnosis. Ten cases of PRES and 1 case of sinus thrombosis were detected in phase 1. Two cases of PRES and 2 cases of intracranial hemorrhage were detected in phase 2. Four cases of leukoencephalopathy, 4 cases of PRES, 2 cases of CNS infection, and 1 case of CNS relapse were detected in phase 3.Conclusion: CNS complications after allogenic BMT in pediatric patients could cause a significant clinical problem. MRI can provide early diagnosis and follow-up to monitor treatment changes. Knowing the onset of the presentation of the complication in relation to the chronology of the transplant is important as it provides significant guidance on which causes to consider.

Patterns of central nervous system complications of post-hematopoietic stem cell transplant in pediatric oncology patients: a single institute experience

“…Compared with our study, Emad-Eldin & Abdel-Moeti [17] and Chaudhary et al [10], revealed higher incidence of post-HSCT intracranial hemorrhage in 6 and 3.4%, respectively. Moreover, Gerber et al [19], Emad-Eldin & Abdel-Moeti [17], and Hierlmeier et al [1] reported higher incidences of CVT of 4.6, 3, and 12.2%, respectively.…”

“…Emad-Eldin & Abdel-Moeti's [17] study of 33 postallogenic HSCT patients with CNS complications revealed a 15% incidence of leukoencephalopathy; our study including both allogenic and autologous HSCT patients (525) shows a prominently lower incidence of 1.9%; all of them had undergone AlloSCT, and all of Literature stated that in patients undergoing HSCT, clinically significant cerebral bleeding was more common than symptomatic thrombotic events where both are important causes of morbidity and mortality [18]. Similarly, our study revealed a higher incidence of post-HSCT hemorrhagic episodes (1.5%) compared with CVT (cerebral venous thrombosis) episodes (0.9%).…”