항암치료와 관련된 백질뇌증 1례

A CASE OF ANTINEOPLASTIC TREATMENT-RELATED LEUKOENCEPHALOPATHY

Antineoplastic treatment-related leukoencephalopathy is defined as an entity in which acute or delayed changes in with matter, secondary to chemotherapy and/or radiation, produce cerebral, cerebellar, and/or brainstem dysfunction in the absence of demonstrable, causally microorganism. We experienced a case of antineoplastic treatment-related leukoencepholopathy in an 11 year-old girl who was diagnosed as having acute lymphoblastic leukemia when she was 8 years old. She had 3 episodes of isolated CNS relapse during maintenance chemotherapy. One month prior to admission, she had difficulties. in adaptation of new class and refused to go to school Six days prior to admission, she began to stammer over a few words and at that night, dysarthria became overt. Next morning, locomotor activities were slow and she was not able to salk without assistance and had right foot dragging. Brain MRI revealed diffuse demyelination in deep white matter with mild degree of diffuse ventricular dilatation and prominent subarachnoid space and sulcus. She had received craniospinal irradiation(whole brain 5,040 cGy, spine 1,350 cGy), intrathecal MTX 468mg, and intrathecal Ara-C 1,890mg. Supportive managements including L-tube feeding, steroid, and mannitolization were done without chemotherapy under the impression of antineoplastic treatment-related leukoencephalopathy. Bone marrow relapse was detected during admission. Her general conditions deteriorated and decorticate posture changed to decerebarte posture. She died at 54th hospital day but autopsy was not done.