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Late Effects of Treatment for Childhood Cancer (PDQ®)

  • Posted: 04/23/2004
  • Updated: 08/18/2014

Table 3. Central Nervous System Late Effects

Predisposing Therapy Neurologic Effects Health Screening 
IQ = intelligence quotient; IT = intrathecal; IV = intravenous.
Platinum agents (carboplatin, cisplatin)Peripheral sensory neuropathyNeurologic exam
Plant alkaloid agents (vinblastine, vincristine)Peripheral sensory or motor neuropathy (areflexia, weakness, foot drop, paresthesias)Neurologic exam
Methotrexate (high dose IV or IT); cytarabine (high dose IV or IT); radiation impacting the brainClinical leukoencephalopathy (spasticity, ataxia, dysarthria, dysphagia, hemiparesis, seizures); headaches; seizures; sensory deficitsHistory: cognitive, motor, and/or sensory deficits, seizures
Neurologic exam
Radiation impacting cerebrovascular structuresCerebrovascular complications (stroke, moyamoya, occlusive cerebral vasculopathy)History: transient/permanent neurological events
Blood pressure
Neurologic exam
Neurosurgery–brainMotor and/or sensory deficits (paralysis, movement disorders, ataxia, eye problems [ocular nerve palsy, gaze paresis, nystagmus, papilledema, optic atrophy]); seizuresNeurologic exam
Neurology evaluation
Neurosurgery–brainHydrocephalus; shunt malfunctionAbdominal x-ray
Neurosurgery evaluation
Neurosurgery–spineNeurogenic bladder; urinary incontinenceHistory: hematuria, urinary urgency/frequency, urinary incontinence/retention, dysuria, nocturia, abnormal urinary stream
Neurosurgery–spineNeurogenic bowel; fecal incontinenceHistory: chronic constipation, fecal soiling
Rectal exam
Predisposing Therapy Neuropsychological Effects Health Screening
Methotrexate (high-dose IV or IT); cytarabine (high-dose IV or IT); radiation impacting the brain; neurosurgery–brainNeurocognitive deficits (executive function, memory, attention, processing speed, etc.); learning deficits; diminished IQ; behavioral changeAssessment of educational and vocational progress
Formal neuropsychological evaluation