Cerebral demyelination syndrome in a patient treated with 5-fluorouracil and levamisole: The use of thallium SPECT imaging to assist in noninvasive diagnosis--A case report

Autor: N. Scott Litofsky, Diane M. F. Savarese, Robert Licho, Lawrence Recht, Jeffrey Gordon, Thomas W. Smith, Ronald Ragland
Rok vydání: 1996
Předmět:
Zdroj: Cancer. 77:387-394
ISSN: 1097-0142
0008-543X
Popis: BACKGROUND The use of 5-fluorouracil (5-FU) and levamisole in patients with Stage III adenocarcinoma of the colon has now become standard. There have been several reports of a multifocal cerebral demyelination syndrome following 5-FU and levamisole administration. METHODS We describe a patient who developed focal neurologic symptoms while being treated with levamisole and 5-FU in whom the diagnosis of central nervous system (CNS) metastases was considered. RESULTS A magnetic resonance imaging (MRI) scan showed a diffuse, multifocal white matter process. Diagnostic evaluation did not support a diagnosis of CNS metastasis. 201Thallium chloride single photon emission computed tomography (SPECT) study was cold. A stereotactic brain biopsy disclosed demyelination but not tumor. The patient had complete functional resolution of symptoms with 1 month of dexamethasone therapy, although follow-up MRI scans have shown persistent abnormality on T2-weighted images. CONCLUSIONS In patients receiving 5-FU and levamisole who develop focal neurologic symptoms with an abnormal MRI scan, the diagnosis of CNS metastasis should not be made without a thorough diagnostic evaluation. We suggest the use of 201thallium chloride SPECT imaging to support the diagnosis of multifocal leukoencephalopathy related to 5-FU and levamisole. In atypical cases, a stereotactic brain biopsy may be required for confirmation. Cancer 1996;77:387-94.
Databáze: OpenAIRE
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