Parenchymatous degeneration of the central nervous system in childhood leukemia

A 7‐year‐old boy with acute lymphocytic leukemia suffered increasing dementia, seizures, ataxia, and spasticity. The neuropathologic findings appeared unique, and included extensive fibrillary gliosis, with lesser degrees of myelin loss and axonal dystrophy. Similar though less severe findings were observed on re‐examination of CNS tissues from 23 other children who died of leukemia. Subcortical fibrillary gliosis was particularly prominent in 22 of 23 cases, and occurred symmetrically in the subependymal and subpial regions, inferior olives, cerebellar roof nuclei, substantia nigra, internal and external capsules, subventricular nuclei, basis pontis, and ventral horns of the spinal cord. The subcortical fibrillary gliosis was out of proportion to the myelin pallor and was not associated with leukemic infiltration. Alzheimer Type II glia were also present diffusely in 22 of 24 cases. No clear etiologic association could be established between the severity of the neuropathologic alterations and the following actors: age at death, duration of illness, elevated intracranial pressure, or treatment regimens. However, the reported case demonstrated the most severe parenchymatous changes at autopsy and received the most intensive treatment of the CNS. This association suggests that the neurologic deterioration may be the consequence of antileukemic treatment. Additional studies to define the frequency of such CNS abnormalities and the factors leading to their development are needed.