Transient posterior encephalopathy induced by chemotherapy in children

Pediatr Neurol. 2001 Feb;24(2):145-8. doi: 10.1016/s0887-8994(00)00242-3.


The cases of three children, 16, 12, and 12 years of age, who suffered sudden confusional state and cortical blindness lasting 12 to 30 minutes while under treatment with high-dose methotrexate, cyclophosphamide, and dactinomycin for a lower limb osteosarcoma are reported. Transient neuropsychologic deficits arose after the acute phase of treatment: left hemispatial neglect and constructive apraxia (Patient 1); constructive apraxia (Patient 2); and constructive apraxia and alexia without aphasia (Patient 3). The three patients recovered completely from all their deficits within the time frame of 3 hours to 2 weeks. Arterial hypertension and hypomagnesemia were found during the acute phase in all patients. In Patients 2 and 3, magnetic resonance imaging revealed increased parieto-occipital T(2) signal involving gray and white matter. In Patients 1 and 2, HmPAO-SPECT revealed parieto-occipital hypoperfusion that resolved a few days later. The alterations detected by neuroimaging were concurrent with the appearance and disappearance of the clinical symptoms. Such transient acute episodes have been named occipital-parietal encephalopathy. On the basis of our clinical, laboratory, and neuroimaging findings, an explanation for the origin of this syndrome, a migrainelike mechanism, triggered by chemotherapy-induced hypomagnesemia, is proposed.

Publication types

  • Case Reports

MeSH terms

  • Acute Disease
  • Adolescent
  • Antineoplastic Combined Chemotherapy Protocols / adverse effects*
  • Brain / blood supply
  • Brain / pathology
  • Child
  • Cyclophosphamide / adverse effects
  • Dactinomycin / adverse effects
  • Female
  • Humans
  • Hypertension / chemically induced
  • Magnesium Deficiency / chemically induced
  • Male
  • Methotrexate / adverse effects
  • Neurotoxicity Syndromes / diagnostic imaging
  • Neurotoxicity Syndromes / etiology*
  • Neurotoxicity Syndromes / pathology
  • Osteosarcoma / drug therapy*
  • Radiopharmaceuticals
  • Remission Induction
  • Syndrome
  • Technetium Tc 99m Exametazime
  • Tomography, Emission-Computed, Single-Photon / methods


  • Radiopharmaceuticals
  • Dactinomycin
  • Technetium Tc 99m Exametazime
  • Cyclophosphamide
  • Methotrexate