(CR 45) Transient Cerebral Ischemia In An Infant Following Intra-Arterial Chemotherapy (IAC) For Retinoblastoma.

Introduction:

Retinoblastoma (RB) is the most common intraocular malignancy in children. Intra-arterial chemotherapy (IAC) is gaining importance in the management of retinoblastoma; however, it has its own set of complications. We report a case of a 7-month-old child with RB whom was managed with IAC, however complicated with an acute right MCA territory cerebral infarct.

Case Presentation:

A 7-month-old girl, presented with 3 weeks history of right eye mild redness and leukocoria.  Examination under anesthesia showed  unilateral right eye group E retinoblastoma. Three cycles of systemic chemo-reduction involving Carboplatin, Etoposide and Vincristine as bridging therapy was given before deciding for IAC. IAC was conducted by a pediatric interventional radiologist under general anesthesia. Child was hemodynamically stable throughout the procedure. Intra-arterial (IA) Topotecan and IA Melphalan were injected into ophthalmic artery uneventfully. 12 hours post procedure, the child developed recurrent episodes of left sided focal seizures. CT and MRI brain showed features of acute right middle cerebral artery (MCA) territory cerebral infarction. Intravenous phenytoin maintenance and oral Aspirin was initiated. Child then remained fit free and had complete neurological deficit recovery at day four post IAC.

Discussion/Conclusion:

Although it is rare, a stroke could be a fatal complication which can develop after an IAC. Hence, it is important to explain this complication during consultation to caretakers prior to the procedure as well as to recognize any neurological deficit promptly to allow immediate steps and treatment to be advocated for a favorable outcome.