Abstract Details

Title Severe Adrenergic Vasomotor Failure Secondary to Cisplatin Chemotherapy

Topic Peripheral Nerve

Presentation(s) P07 - (-)

Poster/Presentation
Number 054

Objective

Background BACKGROUND: Cisplatin commonly causes a large-fiber axonal sensory peripheral neuropathy by inducing apoptosis of dorsal root ganglion cells. Despite similar lack of blood brain barrier protection to postganglionic autonomic neurons, symptomatic autonomic involvement is rare (Podratz 2011, Tuaillon 2004).

Design/Methods DESIGN/METHODS: We report a case of cisplatin causing adrenergic vasomotor failure manifesting as orthostatic hypotension and recurrent syncope in a 59-year-old man. Cisplatin was given as part of R-DHAP chemotherapy for relapsed diffuse large B-cell lymphoma. Symptomatic orthostatic hypotension developed acutely with the first cycle of treatment and worsened with subsequent treatment. Neurologic examination was remarkable for orthostatic hypotension, diffuse hyporeflexia, and reduced sensation to all modalities in a stocking-and-glove distribution.

Results RESULTS: Vascular adrenergic components of the autonomic reflex screen were markedly abnormal, with progressive blood pressure drop during tilt table testing and excessive early phase II, absence of late phase II and IV, and prolonged blood pressure recovery time during Valsalva maneuver. Postganglionic sudomotor testing was normal. Heart rate response to deep breathing was mildly reduced. Thermoregulatory sweat test showed minimal focal anhidrosis involving less than 1% of anterior body surface area. EMG and nerve conduction studies showed a mild length-dependent sensorimotor peripheral neuropathy that predated cisplatin administration and was probably secondary to vincristine given for his initial lymphoma presentation 16 years earlier. Extensive blood and urine tests for alternative causes of autonomic dysfunction were normal or negative. Liberalization of fluid and salt intake and use of compression stockings and abdominal binder provided sufficient symptomatic relief. Cisplatin was not given with subsequent cycles of chemotherapy, and he had a favorable lymphoma response that allowed him to proceed to autologous stem cell transplantation.

Conclusions CONCLUSIONS: Cisplatin is a commonly used chemotherapeutic agent with the potential for severe sensory neuropathy. Autonomic failure may be an additional treatment complication in rare patients. Further study is needed.

Authors/Disclosures
Jeremy K. Cutsforth-Gregory, MD, FAAN (Mayo Clinic) PRESENTER	Dr. Cutsforth-Gregory has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for AAN. Dr. Cutsforth-Gregory has received publishing royalties from a publication relating to health care.
Thomas Haberman, MD (Mayo Clinic Hematology Dept)	No disclosure on file
Michelle L. Mauermann, MD, FAAN (Mayo Clinic)	The institution of Dr. Mauermann has received research support from Intellia. Dr. Mauermann has received publishing royalties from a publication relating to health care.
	No disclosure on file

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