Intracranial Hemorrhage Following Intrathecal Methotrexate T
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Case Report

A 2½-year-old girl presented with a 2 week history of fever, progressive pallor, petechial spots, hepato-splenomegaly and generalized lymphadenopathy. She was diagnosed as ALL Type L1 (FAB classification); CNS involvement was excluded by cerebrospinal fluid (CSF) analysis in the pre-treatment period. She was categorized as standard risk group and was then put to induction phase 1A of chemotherapy with prednisolone, vincristine, daunorubicine, L-asparaginase and intrathecal methotrexate.

Following completion of induction phase 1A, patient showed initial remission as evident by repeat bone marrow examination. Phase 1B of induction therapy was then started with 6-Mercaptopurine, cylophosphamide, cytarabine and intrathecal methotrexate. On 3rd day after receiving last dose of intrathecal methotrexate, patient developed vomiting, sudden onset generalized tonic-clonic seizure and alteration of consciousness. Blood pressure was measured as 112/78 mmHg. There was no history of trauma or any leak of CSF from the lumbar puncture site. Patient was shifted to pediatric intensive care unit. Complete blood count (CBC) revealed hemoglobin 9.7 g/dL, white blood cell count 3.6×103/µL and platelet count 140×103/µL. Coagulation profile showed normal prothrombin time and activated partial thromboplastin time. Non-contrast axial computed tomography (CT) scan of brain showed ventricular and subarachnoid hemorrhage....

http://www.indianpediatrics.net/may2016/may-423-424.htm
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