Manuella Pacífico de Freitas Segredo

Methotrexate (MTX) is widely used in the treatment of acute lymphoblastic leukemia (ALL) in children but is associated with neurotoxic effects, including leukoencephalopathy (LE). These effects can profoundly affect quality of life and neurocognitive development. We conducted a literature review across multiple databases between 2014 and 2024. The study population included children and adolescents with cancer (under 22 years old) treated with MTX, focusing on LE. Case reports, case series, and reviews were excluded. We analyzed factors such as age, dose, and route of administration (intrathecal or intravenous), correlating clinical and imaging data with neurocognitive outcomes. We included 12 of the 262 identified studies. Most studies involved survivors of childhood cancer diagnosed with ALL (n = 11). LE presented heterogeneously, with clinical manifestations such as seizures, focal neurological deficits, and subtle cognitive declines, particularly in working memory and processing speed. A substantial portion of the lesions persisted even after treatment completion, emphasizing the link between white matter microstructural changes and MTX use. Results indicated that the combination of age and cumulative dose acted as the primary determinant of vulnerability. MTX-induced LE is a significant clinical challenge. Early detection and longitudinal monitoring are crucial to minimize neurocognitive impacts in pediatric survivors. Future research should focus on strategies to mitigate neurotoxicity and optimize quality of life for ALL survivors.

Introduction: Ventriculoperitoneal (VP) shunts are widely used to manage hydrocephalus providing significant relief from cerebrospinal fluid (CSF) accumulation. However, abdominal complications, such as aseptic ascites, can occur, albeit rarely. This condition is characterized by the diffuse accumulation of CSF in the peritoneal cavity without evidence of infection, often requiring specific interventions. Case presentation: We present the case of a 3-year-old child with abdominal distension for the past 15 days, without other abnormalities. The child was in the late postoperative period for optic pathway pilocytic astrocytoma, with surgeries performed at 1 year and 7 months of age and VP shunt (VPS) placement at 1 year and 10 months of age. Abdominal ultrasound, computed tomography, and magnetic resonance imaging revealed large-volume ascites without additional findings. Diagnostic paracentesis showed a serum-ascites albumin gradient (SAAG) of 3.1. Biochemical and microbiological analyses showed no signs of infection, and liver, cardiac, and renal function markers were within normal ranges. Cytological analysis revealed no neoplastic cells. A ventriculoatrial shunt was placed, resolving the ascites. Conclusions: Aseptic ascites is a rare dysfunction of VPS, with limited cases reported. Most cases of peritoneal fluid accumulation are associated with shunt infections resulting in peritonitis. In aseptic ascites, however, microbiological analysis of ascitic fluid was negative. Intracranial hypertension symptoms are not usual - typically, the main symptom is abdominal distension without signs of peritonitis. Owing to the high protein accumulation and CSF production in certain conditions, ventriculoatrial shunting is commonly chosen as an alternative.

Oxidative stress is associated with several infectious diseases, as well as the severity of inflammatory reactions. The control of inflammation during parasite destruction is a target of neurocysticercosis treatment, as inflammation is strongly related to symptom severity. In this study, we investigated the presence of malondialdehyde and protein carbonyl, two by-products of reactive oxygen species (ROS), in an experimental model of extraparenchymal neurocysticercosis. Twenty male and twenty female rats were inoculated with 50 cysts of Taenia crassiceps in the subarachnoid space of the cisterna magna. Ten animals (five males and five females) were used as controls. Three months after inoculation, their brains were harvested for oxidative stress and histological assessments. Infected animals had higher scores for inflammatory cell infiltrates, malondialdehyde, and protein carbonyl. These results encourage future efforts to monitor oxidative stress status in neurocysticercosis, particularly in the context of controlling inflammation.