Abstract Details

Title Capecitabine Induced Leukoencephalopathy: Is there a correlation with liver metastases?

Topic General Neurology

Presentation(s) P5 - Poster Session 5 (5:30 PM-6:30 PM)

Poster/Presentation
Number 7-026

Objective This case report demonstrates the rapid onset, cataclysmic presentation, MRI findings in capecitabine induced toxic leukoencephalopathy as well as raising the question of predisposition in patients with liver metastases.

Background

Chemotherapy induced toxic leukoencephalopathy can be caused by several agents including methotrexate and 5FU. A few cases of leukocephalopathy have been reported with the use of the 5FU oral prodrug capecitabine.

Design/Methods 54 year old woman had recurrent breast cancer with liver and lung metastases admitted with progressive generalized weakness, confusion and inability to speak.
She became mute, unable to protrude tongue, had bilateral facial paralysis, skew deviation, dysconjugate gaze to right with anisocoria, quadriparesis and positive Babinski sign bilaterally.

Results MRI brain showed bilateral symmetrical diffusion restriction throughout the white matter including the corpus callosum, greatest in the splenium, involving both lateral thalami and extending into cerebral peduncles with sparing of the inferior frontal lobes.
She had been started on capecitabine 5 days prior to admission and Capecitabine-induced leukocephalopathy was diagnosed, the drug was discontinued and patient’s mental and clinical status improved.

Conclusions

Capecitabine is used for treatment of breast, gastric and colorectal cancer. A few cases of acute multifocal leukoencephalopathy have been reported with the use of capecitabine.
Unlike other 5 FU drugs, the onset is usually rapid within 4 to 7 days.
Toxicity is associated with Dihydropyrimidine dehydrogenase enzyme deficiency which is expressed in the liver and is the rate limiting enzyme in fluoropyrimidine catabolism.
Capecitabine induced leukoencephalopathy may correlate with the presence of liver metastases. Among reported cases, more than half of patients had liver metastases therefore testing for enzyme before starting capecitabine may be justified in patients with liver metastases however more data is needed.
Discontinuation of capecitabine usually results in reversibility of MRI changes and clinical recovery within days.

Authors/Disclosures
Faisal A. Ibrahim, MD (Cleveland Clinic Foundation) PRESENTER	Dr. Ibrahim has nothing to disclose.
Shilpa Chaku, MD (Aurora Neurosciences Innovation Institute)	No disclosure on file
James C. Tanner, MD (Memorial Hospital Belleville)	No disclosure on file
Zara Fatima, MD	No disclosure on file
Hisham G. Elkhider, MD	Dr. Elkhider has nothing to disclose.
James M. Gilchrist, MD, FAAN (Southern Illinois University School of Medicine)	Dr. Gilchrist has received publishing royalties from a publication relating to health care.

��ɫ��

��ɫ��