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⁹⁹Tc^m-HMPAO SPECT and magnetic resonance studies in L-asparaginase induced cerebrovascular accident

Nicholas K. Foreman, MRCP ^* Hazem H. Mahmoud, MB, BCh ^*, and James W. Lanqston, MD ^,

^* Department of Hematology-Oncology, St Jude Children's Research Hospital, PO Box 318, Memphis, TN 38101, USA Department of Diagnostic Imaging, St Jude Children's Research Hospital, PO Box 318, Memphis, TN 38101, USA Department of Pediatrics, University of Tennessee College of Medicine, Memphis, TN, USA Department of Radiology, University of Tennessee College of Medicine, Memphis, TN, USA

This excerpt was created in the absence of an abstract.

Symptoms including malaise and fever over an 8 week period prompted the parents of their 14-year-old daughter to seek medical attention. She was found to be pancytopenic and, after a bone marrow aspirate suggested a diagnosis of acute leukaemia, she was referred to St Jude Children's Research Hospital. Her initial white cell count was 1.4 x 10⁹/1. Examination of the cerebral spinal fluid (CSF) showed no white cells or blasts in a cytospin preparation. She was entered on the current front-line protocol for the treatment of children with acute lymphoblastic leukaemia (St Jude total therapy study XII). Induction therapy comprised of daunorubicin, prednisone, vincristine and L-asparaginase, followed by tenoposide (VM-26) and cytosine arabinoside (Ara-C) on Day 22. Triple intrathecal chemotherapy with methotrexate, hydrocortisone and cytosine arabinoside was given on Day 2. The patient received six doses of Escherichia coli L-asparaginase (Days 3, 4, 6, 8, 10 and 12). After a gynaecology consultation on Day 10, she was started on medroxyprogesterone acetate (Provera) 2.5 mg/day to suppress menstruation during chemotherapy.

On Day 14 of induction therapy the patient had two brief focal seizures, characterized by jerking of the left arm with deviation of the eyes and the head to the left. There was no loss of consciousness. Physical examination revealed a left facial (VII) nerve palsy and weakness of the left arm, but no other abnormalities.

Key Words: Cerebrovascular insult • MR • SPECT • L-asparaginase • ALL

Received for publication March 5, 1991. Revision received June 3, 1991. Accepted for publication July 12, 1991.