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Delayed Cerebral Infarction Following Intra-arterial Chemotherapy for Retinoblastoma

Irina De la Huerta, MD, PhD1; Michael I. Seider, MD1; Steven W. Hetts, MD2; Bertil E. Damato, MD, PhD1
[+] Author Affiliations
1Department of Ophthalmology, University of California, San Francisco
2Department of Radiology, University of California, San Francisco
JAMA Ophthalmol. 2016;134(6):712-714. doi:10.1001/jamaophthalmol.2016.0025.
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This case report describes delayed cerebral infarction following intra-arterial chemotherapy with melphalan for retinoblastoma.

Intra-arterial chemotherapy with melphalan has been used as primary treatment for retinoblastoma since the 1990s, leading to globe conservation in most patients with few adverse events and no neurological complications in previous reports.1 We describe a case of delayed cerebral infarction following ophthalmic artery melphalan administration.

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Figure 1.
Fundus Photographs of the Tumor

A, Initial presentation of the group C tumor in the right macula. B, Tumor after 1 dose of intra-arterial chemotherapy.

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Figure 2.
Magnetic Resonance Imaging and Magnetic Resonance Angiography

A and B, Magnetic resonance imaging showing foci (arrowheads) of reduced diffusion in the subcortical white matter (A) and precentral gyrus (B) of the right frontal lobe. C, Time-of-flight magnetic resonance angiography showing absence of the right A1 segment of the anterior cerebral artery (arrowhead).

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