Intracerebral calcifications appearing during the course of acute lymphocytic leukemia treated with methotrexate and X rays

Abstract

The authors present the case of a child aged 7 years who suffered from relapsing acute lymphocytic leukemia. Treatment consisting mainly of oral and intrathecal methotrexate and x‐ray therapy produced remission of the hematologic symptoms. Three years after the onset of the leukemia, mental deterioration gradually appeared. Radiography of the skull revealed diffuse bilateral calcium deposits in both cerebral and cerebellar hemispheres. Four years after the onset of the disease, a hematologic relapse occurred. Behavioral disorders became more severe and the child died after a period of seizures and unconsciousness. The main pathologic data obtained by the study of a brain biopsy and after a complete postmortem examination consisted of calcifications located bilaterally in the cerebral and cerebellar cortex. No signs of leukemia were present. Cerebral calcification is an extremely rare complication in the course of the therapy of lymphocytic leukemia. Its possible causes are discussed.

Intrathecal methotrexate affects cognitive function in children with medulloblastoma

“…14,15 The pathogenetic mechanism of these disturbances is probably disruption of the numerous connections linking the cerebellum, through the thalamus, to the association cortex, particularly the prefrontal areas. [21][22][23] The white matter areas most frequently involved are the centrum semiovale and periventricular regions, but involvement is usually multifocal and asymmetric. 13,17 IV chemotherapy is also responsible for intellectual loss, but less so than radiotherapy.…”

“…13,17 IV chemotherapy is also responsible for intellectual loss, but less so than radiotherapy. 22,25,26 The two therapies combined seem to have a synergistic action 20,27,28 : while reducing the drug dose and dose and field of radiotherapy in young children, the combination seems to reduce but not eliminate the intellectual damage, as does the use of nonconvention fractionation. [21][22][23] The white matter areas most frequently involved are the centrum semiovale and periventricular regions, but involvement is usually multifocal and asymmetric.…”

Intracerebral (parenchymal) infusion of methotrexate: report of a case

“…Axonal pathology is also a frequent pathological finding in leukoencephalopathy of MTX, manifested as axonal loss [4], swellings [14], or neuronal calcification along with extracellular calcium deposition [21]. Additionally, in experimental MTX toxicity in cats, the most prevalent alteration observed in affected white matter were hydropic swelling of axons followed by the formation of argyrophilic axonal spheroids and macrophage infiltration [16].…”

Female Pelvis: Genital Organs

“…Furthermore, the dynamics of CSF fl ow and renal clearance of chemotherapeutics also regulate the severity and process of leukencephalopathy, since higher area-under-the-curve values are associated with an increased risk of leukencephalopathy. Last but not least, methotrexate and/or irradiation, respectively, may increase the sensitivity of neuronal tissue to subsequent treatment with additional chemotherapy (Flament-Durand et al 1975 ).…”