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
✍ Scribed by Diane M. Savarese; Jeffrey Gordon; Thomas W. Smith; N. Scott Litofsky; Robert Licho; Ronald Ragland; Lawrence Recht
- Publisher
- John Wiley and Sons
- Year
- 1996
- Tongue
- English
- Weight
- 804 KB
- Volume
- 77
- Category
- Article
- ISSN
- 0008-543X
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✦ Synopsis
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.