Walters Courtney,  Pfeifer Cory,  Long Clayton,  Retson Laura,  Vaughn Jennifer

Final Pr. ID: Poster #: CR-037

Neurotoxicity is a potential adverse effect from chemotherapeutic agents such as cytarabine (Ara-C) when treating children with acute myeloid leukemia (AML). Ara-C is an antineoplastic antimetabolite that, once activated by deoxycytidine kinase, mimics and competes with natural nucleosides to disrupt DNA synthesis. If present in the nervous system, Ara-C can lead to central nervous system (CNS) (e.g., cerebellar syndrome, encephalopathy, necrotizing leukoencephalopathy, and seizures), spinal cord (e.g., myelopathy), and peripheral nerve (e.g., sensory polyneuropathy) symptoms. Although neuroradiologic literature is sparse and variable, unique cases of neurotoxicity continue to occur.
We present a 2-year-old male with a history of recurrent infections, leg pain at night, weight loss, and night sweats, who was diagnosed with AML and started on an intrathecal (IT) and intravenous chemotherapy regimen (i.e., Ara-C, daunorubicin, etoposide, and methotrexate). During Intensification II, several days after receiving their fourth dose of IT Ara-C and two weeks after IT methotrexate, the patient developed acute altered mental status, ataxia, and right-sided weakness. MRI brain with and without intravenous contrast showed an atypical expansile region of abnormal signal in the left thalamus, brainstem, temporal lobe, and cerebellum with asymmetric increased perfusion, patchy enhancement, and patchy faint restricted diffusion. There were also patchy non-enhancing areas of white matter signal abnormality and tiny microhemorrhage. MRI of the spine, MR angiography and venography of the brain were normal. The patient’s symptoms gradually improved without intervention with mild residual right-sided weakness and ataxia. Infectious workup was negative. A follow-up brain MRI showed a reduction in the size of lesions. Ara-C was held from the subsequent chemotherapy regimen and symptoms did not recur. This case highlights a unique thalamic and brainstem finding not previously reported in the literature for Ara-C neurotoxicity in pediatric AML. Of the other chemotherapeutic agents, methotrexate (MTX)-induced neurotoxicity remains on the differential, however, such radiographic features are typically characterized by MTX-related leukoencephalopathy of the central white matter, which we do not see in this case. Altogether, Ara-C neurotoxicity should remain on the differential for children with neurological symptoms after receiving this agent. Read More

Authors:  Walters Courtney , Pfeifer Cory , Long Clayton , Retson Laura , Vaughn Jennifer

Keywords:  MRI Brain, Neuroradiology, Central Nervous System

Pfeifer Cory,  Patel Mittun,  Bardo Dianna,  Cornejo Patricia

Final Pr. ID: Poster #: EDU-071

The objective of this exhibit is to illustrate common fetal central nervous system (CNS) abnormalities using high-resolution magnetic resonance imaging at 3.0 Tesla. Read More

Authors:  Pfeifer Cory , Patel Mittun , Bardo Dianna , Cornejo Patricia

Keywords:  fetal, central nervous system

Sun Yan

Final Pr. ID: Poster #: EDU-065

To investigate the radiological findings of central nervous system complications of leukemia (CNSCL）in children. Read More

Authors:  Sun Yan

Keywords:  leukemia, central nervous system, image

Vázquez Elida,  Delgado Ignacio,  Sanchez-montañez Angel,  Escudero Jose,  Gómez David,  Riera Luis

Final Pr. ID: Poster #: EDU-027

Tubulins are a component of microtubules, which are critical to the processes of mitosis, axon navigation, and neuron migration, all key factors in brain development. Mutations in tubulin genes can alter the normal function and structure of microtubules, leading to complex disorders of brain development and brain malformations. Disorders of microtubules formation affect multiple aspects of brain development, resulting in multiple malformations that can be recognized on cranial MRI. A significant characteristic is the wide spectrum of severity, from severe forms often present at birth to milder conditions, sometimes seen in asymptomatic parents of affected individuals.
The purpose of this educational poster is to present the main postnatal and prenatal MRI patterns that can help to suspect a tubulinopathy and guide subsequent genetic testing for confirmation. Read More

Authors:  Vázquez Elida , Delgado Ignacio , Sanchez-montañez Angel , Escudero Jose , Gómez David , Riera Luis

Keywords:  Fetal Brain MRI, Genetics, Central Nervous System