Reversible findings of restricted diffusion in 5‐flourouracil neurotoxicity

Lucato, Leandro Tavares; McKinney, Alexander M.; Short, James H.; Tekşam, Mehmet; Truwit, Chip

doi:10.1111/j.1440-1673.2006.01602.x

Cited by 26 publications

(24 citation statements)

References 16 publications

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“…3 Lesions of 5-FU encephalopathy are most commonly seen in the deep white matter and corpus callosum. 2,3 This present case had clinical characteristics similar to those in previous reports. However, the MR imaging findings disclosed high signal intensities in unusual locations; diffusion-and T2-weightedimages showed involvement of the bilateral basal ganglia and thalami.…”

Section: Case Reportsupporting

confidence: 88%

Atypical Diffusion-Restricted Lesion in 5-Fluorouracil Encephalopathy: Fig 1.

Lee

Kim

Son

et al. 2012

AJNR Am J Neuroradiol

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SUMMARY:Central nervous system toxicity of 5-FU could show various manifestations, such as decreased alertness, disorientation, and agitation. It is generally accepted that lesions of 5-FU encephalopathy are mainly in the deep cerebral white matter and corpus callosum on MR imaging. Here we describe a case of 5-FU encephalopathy in gastric cancer with an atypical reversible diffusion-restricted lesion on MR imaging, showing bilateral basal ganglia, thalami, and parasagittal frontal cortex involvement on diffusion and T2-weighted imaging.ABBREVIATIONS: BUN ϭ blood urea nitrogen; CRF ϭ chronic renal failure; DPD ϭ dihydropyrimidine dehydrogenase; 5-FU ϭ 5-fluorouracil; PT/INR ϭ prothrombin time/international normalized ratio 5-FU is a chemotherapeutic agent that is frequently used to treat breast, head and neck, colon, and stomach cancer. Among the neurotoxic effects of 5-FU, the cerebellar syndrome is the most frequent, whereas encephalopathy is uncommon and mostly reversible.1 Various symptoms of 5-FU encephalopathy include decreased alertness, disorientation, and agitation. It is generally accepted that 5-FU encephalopathy lesions seen on MR imaging are located mainly in deep white matter and the corpus callosum.2,3 Here, we describe a case of 5-FU encephalopathy with atypical diffusion-restricted lesions. Case ReportA 49-year-old man, who had undergone total gastrectomy for gastric cancer 3 months previously, was admitted for chemotherapy to the oncology division. He had a history of hypertension and CRF. He was taking ferrous sulfate, aspirin, furosemide, multivitamins, calcium carbonate, and erythropoietin. The patient had undergone hemodialysis 3 times weekly on a regular basis. He was not a heavy alcohol drinker, and there was no additional significant medical, social, or family history. On initial examination, the patient did not show any abnormal neurologic symptoms or signs. Routine laboratory data indicated anemia and CRF. BUN and creatinine levels fluctuated according to the hemodialysis schedule (36ϳ94 mg/dL and 4.7ϳ6.9 mg/dL, respectively).The patient was administered intravenous 5-FU (410 mg daily) and had no chemotherapy-related symptoms except nausea and vomiting. On the fourth day of the first cycle of 5-FU chemotherapy, he became semicomatose after a nap. He showed intermittent tremulous movement of all extremities and roving eye movements. All brain stem reflexes were intact. Brain MR imaging revealed diffusion restriction in the bilateral basal ganglia, thalami, and parasagittal frontal cortex. High-signal-intensity lesions were detected in the same locations on FLAIR imaging (Fig 1A). His serum ammonia level was high (265 g/dL; normal range, 0 -75 g/dL), and the PT/INR was prolonged to 1.85. His serum thiamine level was within normal limits (115.5 nmol/L), and BUN and creatinine levels were 50 mg/dL and 4.7 mg/dL, respectively. Other laboratory findings, including vitamin B1 and liver function, were unremarkable. An electroencephalogram showed continuous irregular mixed slowing without any e...

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Section: Case Reportsupporting

confidence: 88%

Atypical Diffusion-Restricted Lesion in 5-Fluorouracil Encephalopathy: Fig 1.

Lee

Kim

Son

et al. 2012

AJNR Am J Neuroradiol

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“…Various factors like female gender, malnutrition, or liver dysfunction and dihydropyrimidine dehydrogenase (DPD) deficiency are associated with risk of developing 5-FU-induced leukoencephalopathy [7]. Encephalopathy is dose and schedule dependent and is usually reversible after stopping the offending agent however at times it can result in permanent damage [8,9]. Encephalopathy can be acute to subacute.…”

Section: Discussionmentioning

confidence: 99%

Severe Reversible Form of Chemotherapy Induced Acute Disseminated Leukoencephalopathy: A Case Report with Review of Literature

Raut¹,

Mathur²,

Ambulkar³

et al. 2017

Ann Clin Lab Res

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Leuko-encephalopathy is a disease of the white matter of the brain occurring as a result of various exogenous and endogenous causes. It is one rare, but important cause being use of chemotherapeutic agents. Neurological manifestations are numerous with varying severity. Radiological features are characteristic of leukoencephalopathy well depicted on magnetic resonance imaging (MRI). Here the authors describe case of a gentleman with carcinoma rectum undergoing chemotherapy (5 fluorouracil and oxaliplatin) during which he developed severe encephalopathy with akinetic rigid state. MRI features were characteristic and there was complete clinical recovery and radiological resolution on stopping the causative agent.

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“…The etiologies of transient T2 hyperintense focal lesions in the splenium of the corpus callosum include patients with epilepsy treated with antiepileptic drugs, 35 acute infectious encephalitis (influenza, Escherichia coli, mumps, adenovirus, Epstein-Barr virus, and Rota virus), [36][37][38][39] demyelinating lesions including osmotic myelinolysis, and acute toxic encephalopathy (methotrexate and 5-fluorouracil). [40][41] The present study has several limitations. First, the number of patients included was small, and follow-up MR images were obtained in a limited number of patients.…”

Section: Discussionmentioning

confidence: 99%