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Zhu J, Meng P, Han X, Yang S. Painful Sensory Motor Neuropathy With Albuminocytological Dissociation of the Cerebrospinal Fluid as the Presenting Features of Acute Thallium Poisoning. J Clin Neurol 2023; 19:624-626. [PMID: 37901901 PMCID: PMC10622730 DOI: 10.3988/jcn.2023.0060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 05/12/2023] [Accepted: 08/02/2023] [Indexed: 10/31/2023] Open
Affiliation(s)
- Juehua Zhu
- Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Pin Meng
- Department of Neurology, The First People's Hospital of Lianyungang, Lianyungang, China
| | - Xiang Han
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China.
| | - Shilin Yang
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China.
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Lee EC, Lee DG. Progressive Lower Extremity Paralysis Caused by Intrathecal MTX-Induced Myelopathy Mimicking Guillain-Barre Syndrome: A Case Report. Diagnostics (Basel) 2023; 13:3337. [PMID: 37958233 PMCID: PMC10649159 DOI: 10.3390/diagnostics13213337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 10/28/2023] [Accepted: 10/28/2023] [Indexed: 11/15/2023] Open
Abstract
Methotrexate (MTX) is commonly used in intrathecal chemotherapy for patients with acute lymphocytic leukemia (ALL) to prevent central nervous system (CNS) involvement. However, the use of MTX-based chemotherapy can lead to rare yet severe complications, such as MTX-induced myelopathy. Here, we report the case of MTX-induced myelopathy initially misdiagnosed as Guillain-Barre syndrome, leading to a delay in diagnosis and treatment. We present a case of a 39-year-old male with a history of B-cell acute lymphoblastic leukemia (B-ALL) who experienced bilateral foot paresthesia and progressive lower extremity weakness after intrathecal methotrexate (MTX) treatment. Initially, the patient was suspected as having Guillain-Barre syndrome (GBS) due to similar clinical features and nerve conduction studies. The patient received intravenous immunoglobulin (IVIG) treatment, but his condition worsened. T2-weighted images of the thoracic spinal cord revealed high signal intensity in both lateral and posterior columns, typically associated with subacute combined degeneration. However, elevated vitamin B12 levels ruled out SCD in this case. Based on the aforementioned findings, intrathecal methotrexate-induced myelopathy was diagnosed. This case highlights the diagnostic challenge posed by the similarity in clinical presentation between MTX-induced myelopathy and GBS. Differentiating between these conditions is critical for appropriate management. Prompt recognition and treatment with folate metabolism compounds may mitigate neurological sequelae.
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Affiliation(s)
| | - Dong Gyu Lee
- Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Daegu 42415, Republic of Korea;
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Peripheral Nervous System Involvement in Non-Primary Pediatric Cancer: From Neurotoxicity to Possible Etiologies. J Clin Med 2021; 10:jcm10143016. [PMID: 34300182 PMCID: PMC8303855 DOI: 10.3390/jcm10143016] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 06/28/2021] [Accepted: 06/28/2021] [Indexed: 01/21/2023] Open
Abstract
Peripheral neuropathy is a well described complication in children with cancer. Oncologists are generally well aware of the toxicity of the main agents, but fear the side effects of new drugs. As chemotherapeutic agents have been correlated with the activation of the immune system such as in Chemotherapy Induced Peripheral Neuropathy (CIPN), an abnormal response can lead to Autoimmune Peripheral Neuropathy (APN). Although less frequent but more severe, Radiation Induced Peripheral Neuropathy may be related to irreversible peripheral nervous system (PNS). Pediatric cancer patients also have a higher risk of entering a Pediatric Intensive Care Unit for complications related to therapy and disease. Injury to peripheral nerves is cumulative, and frequently, the additional stress of a malignancy and its therapy can unmask a subclinical neuropathy. Emerging risk factors for CIPN include treatment factors such as dose, duration and concurrent medication along with patient factors, namely age and inherited susceptibilities. The recent identification of individual genetic variations has advanced the understanding of physiopathological mechanisms and may direct future treatment approaches. More research is needed on pharmacological agents for the prevention or treatment of the condition as well as rehabilitation interventions, in order to allow for the simultaneous delivery of optimal cancer therapy and the mitigation of toxicity associated with pain and functional impairment. The aim of this paper is to review literature data regarding PNS complications in non-primary pediatric cancer.
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Roy PS, Banerjee A, Tripathi M, Suthar R, Trehan A. CNS relapse of childhood ALL: More than meets the eye. PEDIATRIC HEMATOLOGY ONCOLOGY JOURNAL 2021. [DOI: 10.1016/j.phoj.2021.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Yildiz FG, Temucin ÇM. Vincristine-induced neurotoxicity: electrophysiological features in children. Neurol Res 2016; 38:124-9. [DOI: 10.1080/01616412.2016.1139321] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Bhushan B, Bhargava A, Kasundra GM, Shubhakaran K, Sood I. Guillain-Barre syndrome in acute lymphoblastic leukemia: Causal or coincidental. J Pediatr Neurosci 2015; 10:64-6. [PMID: 25878750 PMCID: PMC4395952 DOI: 10.4103/1817-1745.154358] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Guillain–Barre syndrome (GBS) is rarely reported in children with acute lymphoblastic leukemia (ALL) and may be difficult to differentiate from vincristine induced neuropathy. Only few case reports highlighted GBS with ALL. We report a 10-year-old male child who was a diagnosed case of ALL since 3 month on chemotherapy. At 3rd week of chemotherapy, he developed rapidly progressive ascending motor quadriparesis over 2 days. Clinical and electrophysiology revealed acute motor axonal neuropathy (AMAN) variant of GBS. He was treated with intravenous immunoglobulin (2 g/kg) without discontinuing chemotherapy. Complete recovery took 12 weeks despite immunotherapy, and it was corroborating to slow remission. We concluded that AMAN variant is usually present in B-cell type ALL, may be causal for GBS and it takes 6–16 weeks to complete recovery which may correspond to remission of ALL. However, it needs to be studied. We also present a meta-analysis of previously reported cases of GBS in ALL.
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Affiliation(s)
- Bharat Bhushan
- Department of Neurology, Dr. S.N. Medical College and M.G. Hospital, Jodhpur, Rajasthan, India
| | - Amita Bhargava
- Department of Neurology, Dr. S.N. Medical College and M.G. Hospital, Jodhpur, Rajasthan, India
| | - Gaurav M Kasundra
- Department of Neurology, Dr. S.N. Medical College and M.G. Hospital, Jodhpur, Rajasthan, India
| | - Khichar Shubhakaran
- Department of Neurology, Dr. S.N. Medical College and M.G. Hospital, Jodhpur, Rajasthan, India
| | - Isha Sood
- Department of Medicine, Dr. S.N. Medical College and M.G. Hospital, Jodhpur, Rajasthan, India
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Park SB, Goldstein D, Krishnan AV, Lin CSY, Friedlander ML, Cassidy J, Koltzenburg M, Kiernan MC. Chemotherapy-induced peripheral neurotoxicity: a critical analysis. CA Cancer J Clin 2013; 63:419-37. [PMID: 24590861 DOI: 10.3322/caac.21204] [Citation(s) in RCA: 457] [Impact Index Per Article: 41.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2013] [Revised: 08/14/2013] [Accepted: 08/23/2013] [Indexed: 12/11/2022] Open
Abstract
With a 3-fold increase in the number of cancer survivors noted since the 1970s, there are now over 28 million cancer survivors worldwide. Accordingly, there is a heightened awareness of long-term toxicities and the impact on quality of life following treatment in cancer survivors. This review will address the increasing importance and challenge of chemotherapy-induced neurotoxicity, with a focus on neuropathy associated with the treatment of breast cancer, colorectal cancer, testicular cancer, and hematological cancers. An overview of the diagnosis, symptomatology, and pathophysiology of chemotherapy-induced peripheral neuropathy will be provided, with a critical analysis of assessment strategies, neuroprotective approaches, and potential treatments. The review will concentrate on neuropathy associated with taxanes, platinum compounds, vinca alkaloids, thalidomide, and bortezomib, providing clinical information specific to these chemotherapies.
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Affiliation(s)
- Susanna B Park
- RG Menzies Fellow, Institute of Neurology, University College London, London, United Kingdom; Neuroscience Research Australia and Prince of Wales Clinical School, University of New South Wales, Sydney, New South Wales, Australia
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Rajeswari B, Krishnan S, Sarada C, Kusumakumary P, Mehta K, More V, Chitale A, Khubchandani S, Kaur A, Khetarpal S, Kumar A, Asaf BB, Chugh K, Talwar N, Sanklecha M, Sundaresan S, Reddy KRBK, Biswas A, Sahu JK, Singh V, Sharath BN, Kumar CM, Patwari AK, Kaur B, Gupta A. Case reports and Correspondence. Indian Pediatr 2013; 50:791-2. [DOI: 10.1007/s13312-013-0201-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Brigo F, Balter R, Marradi P, Ferlisi M, Zaccaron A, Fiaschi A, Frasson E, Bertolasi L. Vincristine-related neuropathy versus acute inflammatory demyelinating polyradiculoneuropathy in children with acute lymphoblastic leukemia. J Child Neurol 2012; 27:867-74. [PMID: 22241706 DOI: 10.1177/0883073811428379] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The objective of this study was to evaluate whether electroneurography could help in differentiating between vincristine-induced neuropathy and acute inflammatory demyelinating polyradiculoneuropathy. We performed electroneurography in 7 children from September 2006 to March 2009 admitted to receive chemotherapy including vincristine for acute lymphoblastic leukemia, in whom severe acute limb weakness developed, suggesting vincristine-induced neuropathy. Three of 7 patients had electroneurography, suggesting acute inflammatory demyelinating polyradiculoneuropathy. They received intravenous immunoglobulins without discontinuing chemotherapy, and within 10 days their electroclinical conditions improved. Although electroneurography showed only absent F waves, preventing us from reaching a definitive neurophysiological diagnosis of acute inflammatory demyelinating polyradiculoneuropathy, children's presenting clinical manifestations, their disease course, and rapid and complete recovery after intravenous immunoglobulins argued strongly in its favor. A prompt, correct differential diagnosis of vincristine neuropathy and acute inflammatory demyelinating polyradiculoneuropathy in patients with acute lymphoblastic leukemia receiving vincristine is essential to improve disease outcome and prolong life expectancy.
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Affiliation(s)
- Francesco Brigo
- Department of Neurological, Neuropsychological, Morphological and Movement Sciences, Section of Clinical Neurology, University of Verona, Verona, Italy.
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Gensicke H, Datta AN, Dill P, Schindler C, Fischer D. Increased incidence of Guillain-Barré syndrome after surgery. Eur J Neurol 2012; 19:1239-44. [PMID: 22519650 DOI: 10.1111/j.1468-1331.2012.03730.x] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2011] [Accepted: 03/13/2012] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND PURPOSE Antecedent surgery has been described to trigger Guillain-Barré syndrome (GBS), but its evidence is poor and based on case reports only. METHODS We performed a retrospective analysis of 63 patients with GBS admitted to the University Hospital Basel and University Children's Hospital Basel from January 2005 to December 2010. We calculated and compared the incidences of post-surgical and non-exposed patients with GBS in the study population and those reported previously in literature. RESULTS Six of 63 (9.5%) GBS cases had had a surgery within 6 weeks prior to GBS. The relative risk of developing GBS during the 6-week period after surgery is 13.1 times higher than the normal incidence in the study population (95% confidence interval: 5.68, 30.3; P ≤ 0.0001), suggesting an attributable risk of 4.1 cases per 100, 000 surgeries. In addition, the incidence of post-surgical GBS is significantly higher than influenza vaccine-associated GBS in the study population (P = 0.01) as well as in comparison with previous reported vaccine-associated GBS (P ≤ 0.0001) and background incidences (P ≤ 0.0001). CONCLUSION Surgery must be considered to be a potential risk factor for developing GBS.
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Affiliation(s)
- H Gensicke
- Department of Neurology, University Hospital Basel, Basel, Switzerland
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Bahl A, Chakrabarty B, Gulati S, Raju KNV, Raja A, Bakhshi S. Acute onset flaccid quadriparesis in pediatric non-Hodgkin lymphoma: vincristine induced or Guillain-Barré syndrome? Pediatr Blood Cancer 2010; 55:1234-5. [PMID: 20544812 DOI: 10.1002/pbc.22684] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Immunological involvement of peripheral nervous system in non-Hodgkin lymphoma (NHL) is very rare and it may be difficult to differentiate it from vincristine-induced neuropathy. We report clinical and electrophysiological findings of an 8-year-old male with NHL who developed acute onset fulminant motor sensory autonomic neuropathy during induction chemotherapy which included vincristine. Characteristic clinical picture and nerve conduction studies favored Guillain-Barré syndrome. The patient improved rapidly with intravenous immunoglobulin and supportive care. It is possible that an immune mechanism damaged the peripheral nervous system in the patient without ruling out the adverse effects of vinca alkaloids.
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Affiliation(s)
- Ankur Bahl
- Department of Medical Oncology, Dr. B.R.A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
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Guillain-Barré syndrome mimicking acute methotrexate-associated encephalopathy in an adolescent patient with lymphoblastic lymphoma. J Pediatr Hematol Oncol 2010; 32:615-6. [PMID: 20463610 DOI: 10.1097/mph.0b013e3181d204b1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
We describe an adolescent case of Guillain-Barré syndrome (GBS) mimicking acute methotrexate-associated encephalopathy during chemotherapy for lymphoblastic lymphoma. Although initial presentations of hemiparesis and irritability were suggestive of acute encephalopathy, the diminished deep tendon reflexes and subsequent rapid progression to flaccid triparesis with bulbar palsy were consistent with GBS. After the initiation of intravenous immunoglobulin therapy her symptoms improved rapidly, and the diagnosis of GBS was confirmed by nerve conduction studies and cerebrospinal fluid examination in recovery phase. GBS should be considered in the differential diagnosis of acute methotrexate-associated encephalopathy, although GBS is a rare neurologic complication.
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Vincristine-induced peripheral neuropathy in a neonate with congenital acute lymphoblastic leukemia. J Pediatr Hematol Oncol 2010; 32:e114-7. [PMID: 20216233 DOI: 10.1097/mph.0b013e3181d419ad] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
We report the case of a 46-day-old boy with a fulminant vincristine-induced peripheral neuropathy after treatment for congenital acute lymphoblastic leukemia. Flaccid paralysis developed at the end of the first phase of induction, requiring intubation and ventilation for 51 days. Treatment was initiated with levocarnitine, N-acetylcysteine, and pyridoxine and progressive reversal of the neuropathy occurred over the next 4 months. Potential differences in pathogenesis and presentation of vincristine neurotoxicity and Guillian-Barre syndrome in the neonate are discussed.
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Romani C, Murru R, Adamo F, Di Tucci A, Sabiu D, Casula P, Angelucci E. Sensorimotor peripheral neuropathy in an elderly AML patient in complete remission while receiving gemtuzumab ozogamicin as maintenance therapy. Ann Hematol 2006; 85:411-2. [PMID: 16538500 DOI: 10.1007/s00277-006-0103-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2006] [Accepted: 02/16/2006] [Indexed: 11/24/2022]
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