Section 3 - Disease related to treatment

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Diffuse necrotizing leukoencephalopathy

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Case 26  

A 41 year old woman with ALL
This patient received intraventricular MTX & ARA-C through an Ommaya reservoir. Other than a peripheral neuropathy felt to be due to Vincristine, she had no CNS symptoms. Yet this MRI shows obvious ependymal enhancement at the site of catheter entrance (arrows). She remains in remission and has never had proven CNS leukemia. These changes have been described and are presumably a toxic effect of concentrated chemotherapy at the ventriculostomy insertion site.

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