Ekici Arzu, Ayan Bilgen, Kazancı Elif Güler, Kuşku Zeynep Beyza, Orcan Cengiz Gökhan, Havalı Cengiz, Dorum Sevil, Metin Taha, Orhaner Betül Biner
Department of Pediatrics, Division of Neurology, Bursa Yuksek Ihtisas Training and Research Hospital, Mimar Sinan Avenue, Yıldırım, Bursa, Turkey.
Department of Pediatrics, Division of Hematology, Bursa Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey.
Acta Neurol Belg. 2025 Feb;125(1):77-88. doi: 10.1007/s13760-024-02602-0. Epub 2024 Aug 27.
Central nervous system (CNS) complications can be seen in patients with leukemia, depending on the disease itself and the chemotherapeutic agents used. This study focused on CNS complications during treatment in children with acute leukemia in a single pediatric institution.
CNS complications were evaluated retrospectively in 115 patients with ALL and AML. Patients with CNS leukemia infiltration at the time of diagnosis or during a neurological event, late-onset encephalopathy, peripheral neuropathy, or a previous history of neurological abnormalities were excluded from the study.
A total of 115 children's clinical records with acute leukemia over a four-year period were reviewed. Acute CNS complications developed in 23.1% of acute myeloid leukemia (AML) patients and in 13.5% of acute lymphoblastic leukemia (ALL) patients. CNS complications developed most frequently during the induction phase of the treatment (66.7%). Seizures were the most common symptom (9 patients, 50%), followed by hemiparesis (4 patients, 22.2%) and headache (4 patients, 22.2%). Six patients (33.3%) had chemotherapy-induced toxic leukoencephalopathy, two (11.1%) had Wernicke's encephalopathy, and one patient (5.6%) each had sinus vein thrombosis, posterior reversible encephalopathy syndrome, and CNS infection. Sequelae occurred in three patients (16.7%), and only one patient (5.6%) died due to a CNS complication.
A wide variety of symptoms can be observed in childhood leukemia, depending on the disease itself, the chemotherapeutic agents used and a lot of other conditions such as nutritional problems. Our research shows that several CNS complications might manifest with similar symptoms; differentiated diagnosis between the underlying etiological reasons can be made by neuroimaging.
白血病患者可能会出现中枢神经系统（CNS）并发症，这取决于疾病本身以及所使用的化疗药物。本研究聚焦于一家儿科机构中急性白血病患儿治疗期间的CNS并发症。
对115例急性淋巴细胞白血病（ALL）和急性髓细胞白血病（AML）患者的CNS并发症进行回顾性评估。诊断时或神经事件期间存在CNS白血病浸润、迟发性脑病、周围神经病变或既往有神经异常病史的患者被排除在研究之外。
回顾了四年期间115例儿童急性白血病的临床记录。23.1%的急性髓细胞白血病（AML）患者和13.5%的急性淋巴细胞白血病（ALL）患者出现了急性CNS并发症。CNS并发症最常发生在治疗的诱导期（66.7%）。癫痫发作是最常见的症状（9例，50%），其次是偏瘫（4例，22.2%）和头痛（4例，22.2%）。6例患者（33.3%）发生了化疗引起的中毒性白质脑病，2例（11.1%）发生了韦尼克脑病，1例患者（5.6%）分别发生了窦静脉血栓形成、后部可逆性脑病综合征和CNS感染。3例患者（16.7%）出现了后遗症，仅有1例患者（5.6%）因CNS并发症死亡。
儿童白血病可能会出现各种各样的症状，这取决于疾病本身、所使用的化疗药物以及许多其他情况，如营养问题。我们的研究表明，几种CNS并发症可能表现出相似的症状；通过神经影像学检查可以对潜在病因进行鉴别诊断。
