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Related Concept Videos

Hepatic Encephalopathy01:29

Hepatic Encephalopathy

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DefinitionHepatic encephalopathy is a reversible neurologic syndrome that results from advanced liver dysfunction or portosystemic shunting. It leads to disturbances in cognition, behavior, and motor function due to the brain’s exposure to gut-derived toxins that the liver fails to detoxify.EtiologyThis condition develops either in the setting of acute fulminant hepatitis or progressively during chronic liver disease, such as cirrhosis and portal hypertension. Portosystemic...
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Encephalitis l: Introduction01:19

Encephalitis l: Introduction

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Encephalitis is inflammation of the brain parenchyma, most often due to infections or autoimmune processes. It presents with neuropsychiatric features such as fever, altered mental status, behavioral changes, cognitive dysfunction, seizures, focal deficits, and sometimes autonomic instability. In some cases, the meninges are also involved, resulting in meningoencephalitis.Infectious CausesInfectious encephalitis is most commonly viral but can also result from bacterial, fungal, or parasitic...
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Encephalitis ll: Pathophysiology01:26

Encephalitis ll: Pathophysiology

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Encephalitis is inflammation of the brain parenchyma caused by direct viral invasion or immune-mediated mechanisms triggered by infections or tumors. Both processes lead to neuronal injury, disrupted neurotransmission, and diverse neurological symptoms, often with overlapping clinical and pathological features.Autoimmune EncephalitisIn autoimmune encephalitis, antibodies target neuronal antigens on cell surfaces, synapses, or within neurons. A key example is anti-NMDAR encephalitis, which can...
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Cytotoxic Edema: Pathophysiology01:21

Cytotoxic Edema: Pathophysiology

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Cytotoxic edema is a form of cerebral edema characterized by intracellular swelling of neurons, astrocytes, and other glial cells. It develops when the mechanisms responsible for maintaining ionic gradients across the cell membrane become impaired. Under normal physiological conditions, the sodium–potassium ATPase actively transports sodium ions out of the cell and potassium ions into the cell, preserving osmotic balance and enabling electrical signaling. This pump requires a continuous...
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Drug toxicity: Idiosyncratic Reactions01:16

Drug toxicity: Idiosyncratic Reactions

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Idiosyncratic drug reactions represent abnormal chemical responses that vary significantly among individuals, ranging from extreme sensitivity to low doses to insensitivity to high doses. These reactions often occur due to the drug's covalent binding with serum proteins, forming a foreign hapten that triggers an immunotoxicological response. The variability in drug reactions has a strong pharmacogenetic foundation, with genetic differences crucial in how individuals metabolize drugs. For...
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Diphtheria01:28

Diphtheria

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Diphtheria is an acute, toxin-mediated infectious disease that primarily affects the upper respiratory tract. It is caused by Corynebacterium diphtheriae, a Gram-positive, pleomorphic rod that lacks spore-forming capability and exhibits a characteristic club-shaped morphology under microscopic examination. While C. diphtheriae can asymptomatically colonize mucosal surfaces, clinical disease manifests only when the bacterial strain is lysogenized by a specific β-corynephage. This phage...
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Updated: Apr 18, 2026

Percutaneous Hepatic Perfusion PHP with Melphalan as a Treatment for Unresectable Metastases Confined to the Liver
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Encephalopathy following melphalan administration.

Divyanshu Dubey1, Matthew Freeman1, Om James Neeley2

  • 1a Department of Neurology , University of Texas South Western Medical Center , Dallas , TX , USA.

Journal of Chemotherapy (Florence, Italy)
|January 13, 2015
PubMed
Summary
This summary is machine-generated.

A rare case of encephalopathy after melphalan treatment in a multiple myeloma patient is presented. Elevated tumor necrosis factor-alpha (TNF-alpha) levels suggest cytokines may cause this serious adverse effect.

Keywords:
CytokinesDialysisEncephalopathyMelphalanMultiple myelomaPlasmapharesisRenal failureTumour necrosis factor-alpha

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Area of Science:

  • Neuroscience
  • Oncology
  • Pharmacology

Background:

  • Melphalan is a chemotherapy agent used for multiple myeloma.
  • Encephalopathy is a rare but serious neurological complication associated with chemotherapy.

Observation:

  • A 59-year-old female with multiple myeloma developed encephalopathy post-melphalan administration.
  • Other potential causes of encephalopathy were excluded.
  • Significantly elevated tumor necrosis factor-alpha (TNF-alpha) levels were detected.

Findings:

  • Elevated cytokines, particularly TNF-alpha, are hypothesized as the cause of melphalan-induced encephalopathy.
  • Plasmapheresis effectively reduced cytokine levels.
  • Patient's neurological status improved following plasmapheresis.

Implications:

  • This case highlights a potential mechanism for melphalan-induced encephalopathy.
  • Monitoring cytokine levels and considering interventions like plasmapheresis may be beneficial in managing this adverse effect.
  • Further research is warranted to elucidate the role of cytokines in chemotherapy-related neurological toxicities.