ASSESSMENT OF BRAIN PERFUSION BY TC-99M-HMPAO SPECT IN AKINETIC MUTISM DUE TO HIGH-DOSE INTRAVENOUS METHOTREXATE THERAPY

Chemotherapy of the central nervous system may cause neurotoxicity in children with acute lymphocytic leukemia. We evaluated regional blood flow in a 6-year-old child presenting with akinetic mutism, using Tc-9 9m-HMPAO single photon emission tomography (SPECT) following high-dose intravenous methotrexate therapy. While findings in X-ray computerize d tomography were decreased density in bilateral basal ganglia and tha lamic nuclei with diffusely decreased attenuation of the periventricul ar white matter, a global, frontal dominant profoundly abnormal perfus ion pattern involving both gray and white matter was observed in the S PECT study. Treatment of the central nervous system with high dose int ravenous chemotherapy may cause profound abnormalities in white and gr ay matter blood flow and early assessment of the neurotoxicity may be identified by Tc-99m-HMPAO SPECT in the pediatric age group.