Delayed leukoencephalopathy with stroke-like presentation in chemotherapy recipients

Area of Science:

• Neuroimaging
• Oncology
• Neurology

Background:

• Chemotherapy, particularly methotrexate, can induce transient leukoencephalopathy mimicking stroke.
• Recent neuroimaging suggests a common pathophysiology across various chemotherapy agents and administration routes.

Purpose of the Study:

• To review literature on chemotherapy-induced leukoencephalopathy presenting as stroke-like episodes.
• To analyze neuroimaging findings in patients receiving chemotherapy.

Main Methods:

• Literature review of case reports and series involving chemotherapy patients with stroke-like episodes.
• Inclusion of studies with detailed neuroimaging data; exclusion of cerebrovascular accidents.
• Analysis of diffusion-weighted imaging (DWI) and apparent diffusion coefficient (ADC) maps.

Main Results:

• 27 reports identified for methotrexate, 5-fluorouracil, carmofur, and capecitabine.
• DWI revealed well-demarcated subcortical white matter lesions exceeding vascular territories.
• Complete symptom resolution and ADC normalization occurred within 1-4 days, though FLAIR showed persistent abnormalities.

Conclusions:

• Chemotherapy-induced leukoencephalopathy presents with characteristic DWI findings of cytotoxic edema.
• Findings support a partially reversible metabolic derangement as the underlying mechanism.
• This syndrome mimics stroke but has distinct imaging features and a generally favorable prognosis.