REVERSIBLE SUPRATENTORIAL AND INFRATENTORIAL MRI SIGNAL ABNORMALITIESAFTER SHORT GENERALIZED SEIZURES DURING CHEMOTHERAPY

Two children on chemotherapy for acute myeloid leukemia (AML) and acut e lymphoblastic leukemia (ALL) had initially focal, then generalized s eizures of short duration. Magnetic resonance imaging (MRI) revealed i n one case minor parietal, cortical and subcortical increased signal o n T2-weighted images. In a second case extended supratentorial lesions and additional signal changes in the cerebellum were found. Although chemotherapy was continued, a few days la ter signal changes were cons iderably reduced or had disappeared. We consider these lesions to be s eizure induced in a brain previously sensitized by chemotherapy.Discus sion: If post-ictal MRI-imaging shows signal changes, differential dia gnosis has to consider other reasons like leukemic infiltrations,encep halitis or hypertensive encephalopathy. However, before extensive diag nostic procedures (e.g. repetitive lumbar punctures) are undertaken, a short-term MRI follow-up should be performed: reversibility within a few days can render the differential diagnosis of transient epileptoge nic changes very likely. A temporary anti-epileptic treatment seems to be indicated. Chemotherapy has not to be suspended.