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Radiation Myelitis in a 5-Year-Old Girl

Department of Pediatrics and Neurology Memorial Sloan-Kettering Cancer Center New York, New York

Susan Wolden, MD

Department of Radiation Oncology Memorial Sloan-Kettering Cancer Center New York, New York

Mark M. Souweidane, MD

Department of Neurosurgery Memorial Sloan-Kettering Cancer Center New York, New York

Eric Lis, MD

Department of Radiology Memorial Sloan-Kettering Cancer Center New York, New York

Marc Rosenblum, MD

Department of Pathology Memorial Sloan-Kettering Cancer Center New York, New York

Peter G. Steinherz, MD

Department of Pediatrics Memorial Sloan-Kettering Cancer Center New York, New York

Myelopathy is an uncommon complication of radiotherapy, particularly in the pediatric age group. A 5-year-old girl with acute lymphoblastic leukemia developed a severe but transient radiculopathy after intrathecal administration of methotrexate and cytarabine for an isolated central nervous system relapse. Chemotherapy was then given through an intraventricular catheter. Owing to a second central nervous system recurrence, she was treated with craniospinal radiation. The whole brain down to the level of C2 received a dose of 2400 cGy. Two months after completion of radiation, the child developed a progressive tetraparesis, and magnetic resonance imaging revealed an enhancing lesion involving the medulla and upper cervical cord. A biopsy was consistent with a treatment-related necrotizing leukoencephalopathy. This case suggests that patients who develop neurologic dysfunction when treated with methotrexate can also be particularly susceptible to radiation-related injury. (J Child Neurol 2002;17:217-219).

Journal of Child Neurology, Vol. 17, No. 3, 217-219 (2002)
DOI: 10.1177/088307380201700312


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