Antineoplastics
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Reactions 885 - 19 Jan 2002 S Antineoplastics Reversible posterior leucoencephalopathy syndrome: case report A 63-year-old woman developed reversible posterior leucoencephalopathy syndrome after receiving cyclophosphamide, doxorubicin, vincristine and prednisolone [CHOP; dosages not stated] for diffuse large B-cell lymphoma, which had been diagnosed after she had presented with a lump in her right breast. She had a history of mesenteric and venous thromboses. Six days after the woman received her first course of treatment with CHOP and prophylactic intrathecal methotrexate, she was hospitalised with a severe occipital headache and left-sided homonymous hemianopia. On hospital day 2, a brain MRI scan showed subtle hyperintense changes in her posterior periventricular white matter, and hyperintensity in her thalami. Her CSF protein level was slightly increased. The woman received tinzaparin sodium and her visual symptoms resolved over the next few days. However, on hospital day 5, she experienced a 1-minute episode of unconsciousness. The next day, her homonymous hemianopia recurred with blurred vision and visual hallucinations. An EEG disclosed right-sided occipital and parietal slow waves and minor left-sided abnormalities. On hospital day 10, a repeat brain MRI scan revealed an abnormally high signal in the deep white matter of both her occipital and parietal lobes. The woman’s visual symptoms resolved over the following week, and she was released from hospital. Three months later, another brain MRI scan revealed almost complete resolution of her white matter changes. Her cancer was subsequently treated with radiotherapy alone. Author comment: ‘The cause of RPLS [reversible posterior leucoencephalopathy syndrome] in this patient is unclear. One of the drugs in her CHOP regimen may have had a toxic effect on her cerebral vasculature. Vincristine has been associated with neurological side effects, most commonly peripheral neuropathy, but also encephalopathy.’ Edwards MJJ, et al. Reversible posterior leukoencephalopathy syndrome following CHOP chemotherapy for diffuse large B-cell lymphoma. Annals of Oncology 12: 1327-1329, Sep 2001 - England 800886237 1 Reactions 19 Jan 2002 No. 885 0114-9954/10/0885-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved
Transcript of Antineoplastics
Reactions 885 - 19 Jan 2002
SAntineoplastics
Reversible posterior leucoencephalopathysyndrome: case report
A 63-year-old woman developed reversible posteriorleucoencephalopathy syndrome after receivingcyclophosphamide, doxorubicin, vincristine and prednisolone[CHOP; dosages not stated] for diffuse large B-cell lymphoma,which had been diagnosed after she had presented with alump in her right breast. She had a history of mesenteric andvenous thromboses.
Six days after the woman received her first course oftreatment with CHOP and prophylactic intrathecalmethotrexate, she was hospitalised with a severe occipitalheadache and left-sided homonymous hemianopia. Onhospital day 2, a brain MRI scan showed subtle hyperintensechanges in her posterior periventricular white matter, andhyperintensity in her thalami. Her CSF protein level wasslightly increased.
The woman received tinzaparin sodium and her visualsymptoms resolved over the next few days. However, onhospital day 5, she experienced a 1-minute episode ofunconsciousness. The next day, her homonymous hemianopiarecurred with blurred vision and visual hallucinations. An EEGdisclosed right-sided occipital and parietal slow waves andminor left-sided abnormalities. On hospital day 10, a repeatbrain MRI scan revealed an abnormally high signal in the deepwhite matter of both her occipital and parietal lobes.
The woman’s visual symptoms resolved over the followingweek, and she was released from hospital. Three months later,another brain MRI scan revealed almost complete resolution ofher white matter changes. Her cancer was subsequentlytreated with radiotherapy alone.
Author comment: ‘The cause of RPLS [reversible posteriorleucoencephalopathy syndrome] in this patient is unclear. Oneof the drugs in her CHOP regimen may have had a toxic effecton her cerebral vasculature. Vincristine has been associatedwith neurological side effects, most commonly peripheralneuropathy, but also encephalopathy.’Edwards MJJ, et al. Reversible posterior leukoencephalopathy syndrome followingCHOP chemotherapy for diffuse large B-cell lymphoma. Annals of Oncology 12:1327-1329, Sep 2001 - England 800886237
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Reactions 19 Jan 2002 No. 8850114-9954/10/0885-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved
