Miyatake S, Kikuchi H, Oda Y, Ishikawa M, Kojima M, Matsubayashi K, Minamikawa J, Yamagata S, Asato R
Department of Neurosurgery, Faculty of Medicine, Kyoto University, Japan.
J Neurooncol. 1992 Oct;14(2):143-9. doi: 10.1007/BF00177618.
A case of treatment-related leukoencephalopathy is presented. A patient with medulloblastoma was postoperatively treated with craniospinal axis irradiation. One month after irradiation, weekly intrathecal administration of methotrexate was performed 4 times to treat cerebrospinal fluid dissemination of the tumor. Two months after the initiation of intrathecal chemotherapy, the patient became somnolent and developed decerebrate posturing. Magnetic resonance imaging showed diffuse leukoencephalopathy. Positron emission tomography revealed a diffuse decrease in glucose uptake in the deep white matter. Auditory evoked potential also showed diffuse abnormalities, not only in the cerebrum, but also in the brain stem. High dose intravenous leucovorin rescue was attempted without any neurologic improvement.
本文报告一例与治疗相关的白质脑病病例。一名髓母细胞瘤患者术后接受了颅脊髓轴照射。照射后1个月，每周进行4次鞘内注射甲氨蝶呤，以治疗肿瘤的脑脊液播散。鞘内化疗开始2个月后，患者出现嗜睡并发展为去大脑强直姿势。磁共振成像显示弥漫性白质脑病。正电子发射断层扫描显示深部白质葡萄糖摄取弥漫性降低。听觉诱发电位也显示弥漫性异常，不仅在大脑，而且在脑干。尝试进行高剂量静脉亚叶酸钙解救，但神经功能无改善。
