5-FU-induced leukoencephalopathy with reversible lesion of splenium of corpus callosum in a patient with colorectal cancer

Acharya, Gyanendra; Carreras, Maria Teresa Cruz; Rice, Terry W.

doi:10.1136/bcr-2017-222030

Cited by 13 publications

(13 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Transient, reversible lesions in the splenium have been described in a wide range of disorders, including viral, bacterial and parasitic infections, treatment of infection with metronidazole, anti-epileptic drug (AED) toxicity or withdrawal, treatment with 5 fluorouracyl, hypoglycemia, hyponatremia and high altitude cerebral edema [31,32,[34][35][36]. Similar lesions have been described on MRI in patients with Wernicke syndrome, with persisting cognitive impairment following thiamine replacement.…”

Section: A1reversible Splenial Lesionsmentioning

confidence: 78%

The splenium of the corpus callosum: embryology, anatomy, function and imaging with pathophysiological hypothesis

Blaauw

Meiners

2020

Neuroradiology

View full text Add to dashboard Cite

Background and purpose The splenium of the corpus callosum is the most posterior part of the corpus callosum. Its embryological development, anatomy, vascularization, function, imaging of pathology, possible pathophysiological mechanisms by which pathology may develop and the clinical consequences are discussed. Methods A literature-based description is provided on development, anatomy and function. MR and CT images are used to demonstrate pathology. The majority of pathology, known to affect the splenium, and the clinical effects are described in three subsections: (A) limited to the splenium, with elaboration on pathophysiology of reversible splenial lesions, (B) pathology in the cerebral white matter extending into or deriving from the splenium, with special emphasis on tumors, and (C) splenial involvement in generalized conditions affecting the entire brain, with a hypothesis for pathophysiological mechanisms for the different diseases.Results The development of the splenium is preceded by the formation of the hippocampal commissure. It is bordered by the falx and the tentorium and is perfused by the anterior and posterior circulation. It contains different caliber axonal fibers and the most compact area of callosal glial cells. These findings may explain the affinity of specific forms of pathology for this region. The fibers interconnect the temporal and occipital regions of both hemispheres reciprocally and are important in language, visuospatial information transfer and behavior. Acquired pathology may lead to changes in consciousness. Conclusion The development, location, fiber composition and vascularization of the splenium make it vulnerable to specific pathological processes. It appears to play an important role in consciousness. AbbreviationAC anterior commissure ACC agenesis of the corpus callosum ADEM acute disseminated encephalomyelitis ADH anti-diuretic hormone AED anti-epileptic drugs AVP arginine-vasopressin CC corpus callosum CLOCC cytotoxic lesions of the corpus callosum DLBCL diffuse large B cell lymphoma GBM glioblastoma multiforme HC hippocampal commissure HIE hypoxic ischemic encephalopathy MERS mild encephalitis/encephalopathy with a reversible splenial lesion PCNSL primary central nervous system lymphoma RESLES reversible splenial lesions syndrome

show abstract

Section: A1reversible Splenial Lesionsmentioning

confidence: 78%

The splenium of the corpus callosum: embryology, anatomy, function and imaging with pathophysiological hypothesis

Blaauw

Meiners

2020

Neuroradiology

View full text Add to dashboard Cite

show abstract

“…Literature review disclosed 26 similar cases (Figure S1, panel B) [9–32], whose clinical−paraclinical features are reported in Table S1. Fifteen patients were female and eleven were male, with a median age of 50.5 (range 23–80) years.…”

Section: Resultsmentioning

confidence: 99%

“…Control MRI, available for 19/26 patients, showed the resolution of diffusion abnormalities but the common persistence of residual T2/FLAIR hypersignal (median time to control MRI 4 weeks, range 1–40 weeks). A single patient reintroduced 5‐FU at a lower dose with no recurrence of neurotoxicity, though it was discontinued early because of intervening tumor progression [26].…”

Section: Resultsmentioning

confidence: 99%

Leukoencephalopathy with transient splenial lesions related to 5‐fluorouracil or capecitabine

Perrain

Bihan

Bompaire

et al. 2021

Euro J of Neurology

View full text Add to dashboard Cite

Background 5‐Fluorouracil (5‐FU) and its oral prodrug capecitabine have been rarely but consistently associated with acute central nervous system toxicity, including transient leukoencephalopathies involving the splenium of the corpus callosum. Methods We performed a retrospective search in the French Pharmacovigilance database (FPDB) (January 1985−July 2020) for adult patients affected by solid cancers who developed acute toxic leukoencephalopathies with splenial lesions following treatment with 5‐FU or capecitabine. A comprehensive review of the literature helped to circumstantiate our findings. Results Our research in the FPDB identified six patients who, within 3 days from their first cycle of 5‐FU or capecitabine, developed acute neurological symptoms, including gait ataxia (n = 4), dysarthria (n = 3), dysmetria (n = 2), headache (n = 2), and confusion (n = 2). Brain magnetic resonance imaging (MRI) showed T2/FLAIR (fluid‐attenuated inversion recovery) hyperintensities in the corpus callosum, with diffusion restriction and no contrast enhancement, generally accompanied by additional alterations in the bilateral supratentorial white matter (n = 5). All patients discontinued the agent supposedly responsible for the toxicity and experienced full recovery after a median of 8.5 days from symptom onset. Control MRI showed a progressive normalization of acute MRI abnormalities. Literature review identified 26 cases with similar clinical and paraclinical characteristics. A single patient from the literature resumed 5‐FU at a lower dose, with no recurrent toxicity. Conclusions 5‐FU and capecitabine might be responsible for acute leukoencephalopathies with transient splenial lesions that are generally reversible upon drug discontinuation. Resuming the agent responsible for toxicity might be feasible in selected cases, after having excluded dihydropyrimidine dehydrogenase deficiency, if expected benefits outweigh the risks.

show abstract

“…CNS toxicity is uncommon and is limited to very few case reports. [ 1 2 3 ] CNS toxicity occurs in the form of sudden onset of slurred speech, confusion, cognitive disturbances, and paranoia. These symptoms usually develop within 7 days from the beginning of the chemotherapy cycle as seen in our patient (on Day 3) and resolve on discontinuation of the drug.…”

Section: Discussionmentioning

confidence: 99%

A unique presentation of 5-fluorouracil (5-FU) induced cerebral encephalopathy

Naik

Vanidassane

Dhamija

et al. 2020

Indian J Radiol Imaging

View full text Add to dashboard Cite

5-Fluorouracil (5-FU), a commonly used antimetabolite and antineoplastic agent, has been approved for the treatment of various cancers. It is associated with systemic side-effects such as gastrointestinal problems, neutropenia. 5-FU-related encephalopathy is very rarely reported. Imaging with computed tomography (CT) and magnetic resonance imaging (MRI) plays a key role in diagnosing and monitoring the changes. Since the prognosis of cerebral involvement is usually good if recognized and treated in time, the reporting radiologist and treating physician should be familiar with them. We present a rare case of 5-FU-induced encephalopathy that was diagnosed based on her clinical and MRI findings and managed successfully.

show abstract

5-FU-induced leukoencephalopathy with reversible lesion of splenium of corpus callosum in a patient with colorectal cancer

Cited by 13 publications

References 20 publications

The splenium of the corpus callosum: embryology, anatomy, function and imaging with pathophysiological hypothesis

The splenium of the corpus callosum: embryology, anatomy, function and imaging with pathophysiological hypothesis

Leukoencephalopathy with transient splenial lesions related to 5‐fluorouracil or capecitabine

A unique presentation of 5-fluorouracil (5-FU) induced cerebral encephalopathy

Contact Info

Product

Resources

About