Transient posterior encephalopathy induced by chemotherapy in children

The eases of three children, 16, 12, and 12 years of age, who suffered sudd en confusional state and cortical blindness lasting 12 to 30 minutes while under treatment with high-dose methotrexate, cyclophosphamide, and dactinom ycin for a lower limb osteosarcoma are reported. Transient neuropsychologic deficits arose after the acute phase of treatment: left hemispatial neglec t and constructive apraxia (Patient 1); constructive apraxia (Patient 2); a nd constructive apraxia and alexia without aphasia (Patient 3), The three p atients recovered completely from all their deficits within the time frame of 3 hours to 2 weeks, Arterial hypertension and hypomagnesemia were found during the acute phase in all patients. In Patients 2 and 3, magnetic reson ance imaging revealed increased parieto-occipital T, signal involving gray and white matter. In Patients 1 and 2, HmPAO-SPECT revealed parieto-occipit al hypoperfusion that resolved a few days later. The alterations detected b y neuroimaging were concurrent with the appearance and disappearance of the clinical symptoms. Such transient acute episodes have been named occipital -parietal encephalopathy. On the basis of oar clinical, laboratory, and neu roimaging findings, an explanation for the origin of this syndrome, a migra inelike mechanism, triggered by chemotherapy- induced hypomagnesemia, is pr oposed. (C) 2001 by Elsevier Science Inc. All rights reserved.