Abstract Details

Title 5-Fluorouracil Neurotoxicity in Patient Without Dihydropyrimidine Dehydrogenase Deficiency

Topic Neuro Trauma, Critical Care, and Sports Neurology

Presentation(s) Neurocritical Care Posters (7:00 AM-5:00 PM)

Poster/Presentation
Number 009

Objective We report a rare and serious encephalopathy and seizure disorder associated with a commonly used chemotherapeutic agent, 5-fluorouracil. Our objective is to make clinicians aware of 5FU-related reversible neurotoxicity even in the absence of dihydropyrimidine dehydrogenase deficiency.

Background

5-Fluorouracil is a commonly-used chemotherapeutic agent for the treatment of various solid malignancies including colon cancer. Common side effects include myelosuppression, nausea, vomiting, diarrhea, mucositis, and skin changes. Neurotoxicity is a rare side effect of 5FU administration and often manifests as confusion, agitation, ataxia, seizure, and coma. Dihydropyrimidine dehydrogenase (DPD) is an enzyme responsible for the breakdown of 5FU. Mutation in the DPD gene has been associated with increased risk of 5FU toxicity.

Design/Methods NA

Results

Case Presentation: We report a case of acute reversible neurotoxicity and refractory status epilepticus in a patient with colorectal adenocarcinoma being treated with leucovorin calcium, 5-fluorouracil and oxaliplatin (FOLFOX) in the absence of DPD deficiency. The patient received uridine triacetate, the antidote for 5FU toxicity. MRI of the brain demonstrated multifocal areas of restricted diffusion which resolved on day ten of uridine treatment.

Conclusions

Clinicians should consider 5FU neurotoxicity in the differential diagnosis of a patient on 5FU chemotherapy who presents with acute unexplained encephalopathy or status epilepticus.

Authors/Disclosures
Rebecca Jules, MD PRESENTER	Ms. Jules has nothing to disclose.
William H. Roth, MD (New York Presbyterian Hospital, Columbia)	No disclosure on file
Katharina M. Busl, MD, MS, FAAN (University of Florida)	Dr. Busl has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Rissman Law. Dr. Busl has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Society of Critical Care Medicine. The institution of Dr. Busl has received research support from University of Florida Self Insurance Program. The institution of Dr. Busl has received research support from National Institutes of Health. Dr. Busl has a non-compensated relationship as a Board Member with Art in Medicine that is relevant to AAN interests or activities. Dr. Busl has a non-compensated relationship as a Associate Editor with Critical Care Explorations that is relevant to AAN interests or activities. Dr. Busl has a non-compensated relationship as a Editorial Board Member with Neurocritical Care that is relevant to AAN interests or activities.
Pouya A. Ameli, MD (University of Florida, Dept of Neurology, Div of Neurocritical Care)	Dr. Ameli has a non-compensated relationship as a Board of Trustees with Neurocritical Care Foundation that is relevant to AAN interests or activities.
Christopher P. Robinson, DO (University of Florida Department of Neurology)	Dr. Robinson has nothing to disclose.
Marc Alain Babi, MD (Cleveland Clinic Foundation (Florida Region))	Dr. Babi has nothing to disclose.
William Roth, MD (University of Chicago)	William Roth has nothing to disclose.

��ɫ��

��ɫ��