American Acute lymphocytic leukemia ALLwhich is known as acute lymphoblastic leukemia. It is a kind of cancer which initiates from white blood cells in the bone marrow which is the soft inner part of the bones called lymphocytes. In some subtypes of acute leukemian, it quickly shifts into the blood from where it can spread to other parts of the body including the lymph nodes, liver, testes, central nervous system that is brain and spinal cord and spleen. In acute lymphocytic leukemia, the bone marrow cells are not properly mature.
Abstract Acute lymphoblastic leukemia ALL is the commonest childhood malignancy with high cure rates due to recent advances in central nervous system CNS prophylaxis. The disease per se, as well as the prophylactic therapy, predisposes the child to complications such as cerebrovascular events, infections, drug toxicities, etc.
The purpose of this study is to highlight the pathophysiology and the imaging features with appropriate examples of these complications and to propose a diagnostic algorithm based on MRI. Interpreting these scans in the light of clinical inputs very often helps the radiologist reach an appropriate diagnosis and help treatment and management.
Acute neurological complications in children with acute lymphoblastic leukemia. Indian J Radiol Imaging ; This therapy is administered using intrathecal methotrexate, high-dose chemotherapy, radiotherapy, or a combination of any of these. However, patients with ALL can present with neurological complications as a result of this therapy and the underlying systemic effects of leukemia.
The neurological complications in ALL can be divided into two broad categories: The latter have been divided into seven categories as shown in [Table 1]. Our review focuses on the complications that have an acute presentation and can be promptly recognized on imaging.
Pathophysiology Leukemia is often associated with leucocytosis, thrombocytopenia, sepsis, or coagulopathy. These factors and certain therapeutic agents like glucocorticoids and L-asparginase used in the management of these tumors, predispose the patient to cerebrovascular events.
Imaging Hemorrhage is seen commonly and is often fatal. The mass effect associated with these lesions leads to complications. Figure 1 A, B: A year-old boy developed altered sensorium followed by loss of consciousness. Plain CT scan A shows a hyperdense lesion arrow in the right frontoparietal region, with surrounding white matter edema and mass effect.
Axial plain T1W MRI B at the corresponding level shows a hyperintense periphery arrow due to presence of intracellular methemoglobin and central hypointensity arrowhead due to deoxyhemoglobin Click here to view The thrombosed dural sinuses appear hyperdense on CT scans, while on MRI they appear hyperintense on plain scans instead of showing the normal void caused by moving blood [Figure 2].
The 'empty delta sign' helps in making a reliable diagnosis of complete sagittal sinus thrombosis on postcontrast CT scans. However, if the sinus is partially thrombosed, then the detection is better with MRI as compared to CT scan.
Thrombosed cortical veins may be seen as hyperdense linear structures extending to the sinuses on plain CT scan the 'cord sign' and as hyperintensities on T1W images. The resultant venous infarctions tend to be nonterritorial and are associated with reperfusion injury and hemorrhage [Figure 2] C.
A year-old female was on induction chemotherapy and receiving L-asparaginase when she developed severe headache.
The contrast-enhanced CT scan A shows an empty delta sign arrow. The walls of the superior sagittal sinus show enhancement, while the center shows a filling defect.
A year-old male presented with headache while receiving induction chemotherapy. Axial plain T1W MRI B shows a dilated right lateral sinus arrow filled with a hyperintense clot suggestive of thrombosis.
The patient also had thrombosis of the superior sagittal sinus; foci of subacute hemorrhage arrow seen as oval areas of altered signal intensity on this axial gradient-echo MRI C Click here to view The arterial infarcts could be lacunar or larger and territorial [Figure 3].
Their imaging appearance is also dictated by the temporal evolution of the ischemic cells. Diffusion-weighted imaging DWI depicts a hyperacute infarct as an area of restricted diffusion even when it is not visible on routine sequences. A year-old female was off therapy when she presented with gaze palsy and neck rigidity.
These serial diffusion-weighted images of the patient depict the evolution of an infarct.This particular childhood leukemia is a type of blood cancer (“Acute Lymphocytic Leukemia” 1).
ALL results from an acquired genetic injury to the DNA of a single cell in the bone marrow (Bellenir ). Acute Lymphoblastic Leukemia, and Acute Lymphoid Leukemia are both synonyms for Acute Lymphocytic Leukemia (Bellenir ).
Essay Case Study 6. Advanced Pathophysiology Case Study 6 Case Study 6 Scenario: John is a 4 year-old boy who was admitted for chemotherapy following diagnosis of acute lymphoblastic leukemia .
Leukemia strikes both children and adults, and while survival rates are high, treatment is often difficult and always expensive. People who have been affected by Leukemia or Lymphoma, either directly or through a family member, understand the physical, emotional, . Methotrexate is historically and currently indicated for use in pediatric populations with various neoplastic disorders, such as acute lymphocytic leukemia, meningeal leukemia, osteosarcoma, some brain tumors, and non-Hodgkin’s lymphoma.
There are two types of acute leukemia, Acute Lymphoblastic Leukemia (ALL) and Acute Myeloid Leukemia (AML). This thesis focuses on Acute Lymphoblastic Leukemia (ALL). Generally, the process of detection and classification is done manually taking up to five days. Abstraction. Summary. Acute lymphoblastic leukaemia (ALL) is the most common signifier of malignance in kids.
Recently, many surveies have examined factors act uponing both the susceptibleness to ALL and the metamorphosis of widely used chemotherapeutic agents.