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Fluorouracil-induced neurotoxicity.
N A Pirzada1, I I Ali, R M Dafer
1Department of Neurology, Medical College of Ohio, Toledo 43614, USA. npirzada@mco.edu
The Annals of Pharmacotherapy
|February 11, 2000
Summary
Fluorouracil can cause acute neurological side effects like confusion, seizures, and cerebellar syndrome. While often dose-related and self-limiting, clinicians must consider this neurotoxicity in patients presenting with neurological symptoms.
Area of Science:
- Neuroscience
- Oncology
- Pharmacology
Background:
- Fluorouracil (5-FU) is a widely used chemotherapeutic agent.
- Neurotoxicity is a known, though less common, adverse effect of 5-FU.
- Understanding the spectrum of 5-FU neurotoxicity is crucial for patient management.
Observation:
- A case of acute neurotoxicity following 5-FU treatment for esophageal carcinoma is presented.
- The patient experienced confusion, cognitive disturbances, cerebellar syndrome, and seizures.
- Brain imaging and CSF analysis were unremarkable, with symptoms resolving partially after treatment.
Findings:
- Fluorouracil can induce both acute and delayed neurotoxicity.
- Acute neurotoxicity may present as encephalopathy, cerebellar syndrome, or rarely, seizures.
- Delayed neurotoxicity, particularly with combination therapy, can manifest as leukoencephalopathy.
Implications:
- Clinicians should maintain a high index of suspicion for 5-FU neurotoxicity.
- Prompt recognition and management can mitigate severe neurological outcomes.
- Awareness of dose-related and immune-mediated neurotoxic mechanisms guides treatment strategies.