We describe a patient with reversible ataxia, nystagmus, and slurred speech from artemisinin-induced toxic brainstem encephalopathy. Artemisinin is a widely used antimalarial drug and new studies are exploring its potential use for cancer treatment. Artemisinin toxicity has not been easily demonstrable in human trials; however, multiple animal studies clearly establish a selective brainstem neurotoxicity from artemisinin. To our knowledge, this is the first reported case of human artemisinin toxicity uncomplicated by malarial infection.
Case Report
We report the case of a 42-year-old woman with recently resected early breast carcinoma without chemotherapy, presenting with 3 days of diplopia, dysarthria, and ataxic gait. Her medications were tamoxifen 20mg and fluoxetine 10mg daily, and 2 weeks of herbal therapy for breast cancer. The herbs consisted of artemisinin tablets 200mg twice a day, and a daily admixture in pill formulation containing Paeonia alba, Atractylodes alba, Momordica, Cochichinensis, Cudrania, Sophora flavenisis, and Dioscorea. All medications were discontinued upon hospital admission. Neurological examination showed conjugate downgaze and prominent vertical nystagmus, dysarthric speech, bilateral incoordination of upper and lower limbs, and unsteady wide-based gait. Physical examination was otherwise normal except for status-post right mastectomy.
Brain magnetic resonance imaging (MRI) showed symmetric punctate foci of T2 signal prolongation (Fig. upper