Wizniter M, Packer R J, Rorke L B, Meadows A T
J Neurooncol. 1987;4(4):353-60. doi: 10.1007/BF00195606.
Cerebral cortical sclerosis is an acquired condition that has rarely been described in cancer patients. We reviewed necropsy findings in all children with cancer who died at the Children's Hospital of Philadelphia during the 20 year period 1963-1982 and found cerebellar sclerosis in 14 children with cancer (12 with acute lymphoblastic leukemia, 1 each with neuroblastoma and osteogenic sarcoma). The lesions were focal (3), multifocal (9) or diffuse (2). They occurred more frequently in children with acute lymphoblastic leukemia who had received intravenous methotrexate therapy. Ten of these 12 children had also received whole brain irradiation. The pathogenesis of the cerebellar sclerosis is unknown, but it is possible that extrinsic cerebellar compression by tumor or chronically increased intracranial pressure may have played a role in 6, ischemia/hypoxia in 3, and methotrexate toxicity in 2. No clear associations could be ascertained in 3. Methotrexate may be a previously unrecognized cause of cerebellar cortical injury. In addition, oncologic treatment regimens that include other central nervous system-penetrating drugs and irradiation may sensitize cerebellar cortex and make it more susceptible to other cerebellar sclerosis-causative factors.
大脑皮质硬化是一种后天性疾病，在癌症患者中很少被描述。我们回顾了1963年至1982年期间在费城儿童医院死亡的所有癌症患儿的尸检结果，发现14名癌症患儿（12名急性淋巴细胞白血病患儿、1名神经母细胞瘤患儿和1名骨肉瘤患儿）存在小脑硬化。病变为局灶性（3例）、多灶性（9例）或弥漫性（2例）。它们在接受静脉甲氨蝶呤治疗的急性淋巴细胞白血病患儿中更常见。这12名患儿中有10名还接受了全脑照射。小脑硬化的发病机制尚不清楚，但肿瘤对小脑的外在压迫或慢性颅内压升高可能在6例中起了作用，缺血/缺氧在3例中起了作用，甲氨蝶呤毒性在2例中起了作用。3例中未发现明确的关联。甲氨蝶呤可能是一种以前未被认识的小脑皮质损伤原因。此外，包括其他可穿透中枢神经系统的药物和放疗的肿瘤治疗方案可能会使小脑皮质敏感，使其更容易受到其他导致小脑硬化的因素的影响。
