Discrimination of Leukoencephalopathy from Leukemic Cell Invasion by MR Spectroscopy in a Patient with Acute Lymphoblastic Leukemia

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  • SUMIKUMA Toshiya
    The Second Department of Medicine, Kyoto Prefectural University of Medicine
  • KIKUTA Takehisa
    The Second Department of Medicine, Kyoto Prefectural University of Medicine
  • HIRAI Hideyo
    The Second Department of Medicine, Kyoto Prefectural University of Medicine
  • SUDO Yoshikazu
    The Second Department of Medicine, Kyoto Prefectural University of Medicine
  • YAMAGATA Noboru
    The Second Department of Medicine, Kyoto Prefectural University of Medicine
  • ASHIHARA Eishi
    The Second Department of Medicine, Kyoto Prefectural University of Medicine
  • GOTO Hideo
    The Second Department of Medicine, Kyoto Prefectural University of Medicine
  • INABA Tohru
    The Second Department of Medicine, Kyoto Prefectural University of Medicine
  • FUJITA Naohisa
    The Second Department of Medicine, Kyoto Prefectural University of Medicine
  • MURAKAMI Satoshi
    The Department of Internal Medicine, Shakaihoken Kyoto Hospital
  • HARUYAMA Harue
    The Department of Internal Medicine, Shakaihoken Kyoto Hospital
  • SHIMAZAKI Chihiro
    The Second Department of Medicine, Kyoto Prefectural University of Medicine
  • NAKAGAWA Masao
    The Second Department of Medicine, Kyoto Prefectural University of Medicine

Bibliographic Information

Other Title
  • 白血病細胞の中枢神経系浸潤と白質脳症の鑑別にMR spectroscopyが有用であった急性リンパ性白血病

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Description

A 58-year-old man was admitted to our hospital in November 1992 because of fever and arthralgia. He was given a diagnosis of acute lymphoblastic leukemia and treated with an Ad-VP regimen, which resulted in complete remission. After two courses of consolidation therapy and intrathecal (IT) injections of methotrexate, Ara-C, and prednisolone the patient received high-dose Ara-C plus VP-16 followed by recombinant human G-CSF for the collection of peripheral blood stem cells. However, he relapsed with the appearance of leukemic cells in cerebrospinal fluid (CSF), and was accordingly given IT injections 8 more times.<br>After the disappearance of leukemic cells from CSF, the patient received a peripheral blood stem cell transplant (PBSCT) and achieved rapid hematopoietic recovery. However, he suffered mental aberrations and loss of consciousness 9 days after PBSCT.<br>Proton magnetic resonance spectroscopy (1H-MRS) disclosed severe necrosis due to leukoence-phalopathy in the frontal lobe and invasion of leukemic cells around the lateral ventricles. The patient did not receive any therapy for neurological symptoms because of severe necrosis in the frontal lobe, and died of bone marrow relapse in April 1995. MRS is useful for the discrimination of leukoencephalopathy from leukemic cell invasion.

Journal

  • Rinsho Ketsueki

    Rinsho Ketsueki 40 (4), 305-310, 1999

    The Japanese Society of Hematology

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