An autopsy was done. The brain and spinal cord was grossly edematous and congested without any specific feature. Histologically, profound loss of neuron was noted in the spinal cord. Remaining neurons in the spinal cord, particularly anterior horn cells were markedly swollen. The spinal nerves show diffuse axonal degeneration and myelin loss.
Several neurons show intracytoplasmic eosinophilic inclusion body.
Myelin loss, axonal swelling and enlargement of perivascular spaces were seen throughout the white matter of central nervous system. AD - Dipartimento di Biotecnologie Cellulari ed Ematologia, University La Sapienza, Rome, Italy. After high-dose induction and consolidation chemotherapy without bone marrow transplantation, all patients had a complete hematologic remission. There was a low incidence of neurologic toxicity and an unexpectedly high rate of allergic reactions to L-asparaginase. For children with ALL and an isolated CNS relapse, treatment that delays definitive craniospinal irradiation by 6 months to allow for more intensive systemic and intrathecal chemotherapy results in better EFS than has been previously reported.