Hypoplasia of the cerebellar vermis and cognitive deficits in survivors of childhood leukemia
K. T. Ciesielski, R. Yanofsky, R. N. Ludwig, D. E. Hill, B. L. Hart, R. S. Astur and T. Snyder
Department of Psychology, University of New Mexico, Albuquerque.
BACKGROUND: Neurodevelopmental evidence of the cerebellum's protracted
course of postnatal development suggests that it is particularly sensitive
to early toxic insult from cancer therapy. If this is the case, one would
expect that there is a relationship between the pattern of
neuropsychological and magnetic resonance imaging deficits and that both
may indicate cerebellar abnormalities. OBJECTIVE: To investigate the
profiles of neuropsychological functions and the morphologic features of
the cerebellum, using in vivo magnetic resonance imaging planimetry in
survivors of acute lymphoblastic leukemia (ALL) treated with radiation and
chemotherapy. DESIGN: Thirteen survivors of childhood ALL with onset at age
2 to 5 years and a uniform protocol of treatment involving cranial
radiation of 24 Gy and five doses of intrathecal methotrexate sodium
participated in the study. Ten controls matched the patients in age and
socioeconomic status. Each child was assessed with a comprehensive battery
of neuropsychological tests and with magnetic resonance imaging of the
brain. MEASUREMENTS: The neuropsychological scores were transformed into z
scores and clustered into right and left hemisphere measures. Planimetric
measures of the cerebellar vermis and pons were collected in the
midsagittal plane. RESULTS: Consistently observed in survivors of ALL were
the following: (1) significant cognitive deficits in visual-spatial-motor
coordination and figural memory, functions commonly related to the right
side of the brain; and (2) hypoplasia of the cerebellar vermis, lobuli I
through V and particularly VI to VII. Lateralization of the neurobehavioral
deficits was not reflected in structural brain abnormalities. CONCLUSIONS:
Coexistence of the cerebellar hypoplasia and visual-motor coordination and
memory deficits supports the neurodevelopmental approach to brain sequelae
in survivors of ALL; it also suggests significance of the cerebellum for
both motor and complex nonmotor cognitive processing.
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