Abstract Details

Title Multifocal Cerebral Infarction and Status Epilepticus as a Result of 3-bromopyruvate Toxicity for Treatment of Ocular Melanoma

Topic Neuro-oncology

Presentation(s) P2 - Poster Session 2 (5:30 PM-6:30 PM)

Poster/Presentation
Number 7-011

Objective To present a case of neurotoxicity associated with 3-bromopyruvate therapy.

Background While surgery, radiation, and/or chemotherapy comprise traditional treatment options for cancer, some patients elect to pursue alternative rather than conventional therapies. Literature regarding potential toxicities associated with certain alternative therapies is lacking.

Design/Methods

N/A

Results A 55 year old woman with recently diagnosed ocular melanoma presented to the emergency department with nonconvulsive status epilepticus after receiving high dose 3-bromopyruvate infusions for 2 consecutive days. Given her depressed level of consciousness, she was intubated and treated with anti-epileptic drugs. CT head revealed low-density changes in the bilateral thalami and left caudate nucleus. MRI brain revealed multiple foci of diffusion restriction involving the left posterior frontal and parietal lobes, left caudate head, and bilateral thalami consistent with recent infarction. There was no evidence of vascular abnormality on MRA or cardioembolic source on echocardiogram. She remained in the ICU for over ten days and required placement of a tracheostomy and gastrostomy tube. After a seventeen day hospitalization, she was discharged to an acute rehab facility with right greater than left sided weakness, gait instability, and cognitive impairment. She utilized a speaking valve to communicate, though her verbal interaction remained limited.

Conclusions The suspected mechanism of infarction in this case was metabolic dysfunction induced by 3-bromopyruvate via glycolysis inhibition, particularly noting the bilateral thalamic involvement. The typical treatment used for ocular melanoma is surgical enucleation or radiotherapy with plaque brachytherapy with the greatest risk being vision loss and disease recurrence. To our knowledge, this is the first case reported use of 3-bromopyruvate in the treatment of ocular melanoma, as well as associated neurotoxicity. We highlight this case to raise awareness regarding the toxicity of an alternative therapy used to treat cancer by naturopathic physicians.

Authors/Disclosures
Abigail M. Taylor, PA (Mayo Clinic Hopsital) PRESENTER	Ms. Taylor has nothing to disclose.
Marie F. Grill, MD (Mayo Clinic)	Dr. Grill has nothing to disclose.
Michael Christiansen, MD	No disclosure on file
Alyx B. Porter, MD, FAAN (Mayo Clinic)	Dr. Porter has a non-compensated relationship as a Board Member with American Brain Foundation that is relevant to AAN interests or activities.

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