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Multifocal Inflammatory Leukoencephalopathy with 5-Fluorouracil and Levamisole
Ann Neurol 31:262-267, Hook,C.C.,et al, 1992
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Article Abstract
The cerebral demyelinating disease developed in 3 patients during adjuvant therapy with 5-fluorouracil and levamisole for adenocarcinoma of the colon.None of the patients had evidence of metastatic disease or prior neurological disease.The duration of chemotherapy before onset of neurological symptoms ranged from 15 to 19 weeks.The total dose of 5- fluorouracil was 9.7 to 15.7 gm.The total dose of levamisole was 2.7 to 3. 75 gm.Two patients presents with a subacute(2-3 weeks)progressive decline in mental status and ataxia.The third patient had two unexplained episodes of loss of consciousness.In each,magnetic resonance imaging with gadolinium demonstrated prominent multifocal enhancing white matter lesions.Cerebral biopsy was performed stereotaxially in 2 patients.The morphological features were those of active demyelinating disease.The myelin loss was associated with numerous dispersed as well as vasocentric macrophages,sparing of axons,and perivascular lymphocytic inflammation. Electron microscopy confirmed the light microscopic findings.All 3 patients improved after cessation of chemotherapy and a short course of corticosteroid therapy.Our patients represent the first reported examples of an inflammatory leukoencephalopathy associated with the administration of 5 fluorouracil and levamisole.This syndrome may represent the pathological basis for 5-fluorouracil neurotoxicity,although we cannot completely exclude the role of levamisole.
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adverse drug reaction
ataxia
brain biopsy
chemotherapy,CNS treatment and complications with
demyelinating disease
fluorouracil
gadolinium
leukoencephalopathy
levamisole
mental status,abnormal
MRI
MRI,abnormal
MRI,contrast enhanced
MRI,demyelinating disease
neurotoxic
pleocytosis of cerebrospinal fluid
syncope
white matter disease
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