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Area of Science:

  • Oncology
  • Neurology
  • Pharmacology

Background:

  • Chemotherapy for stage IV small cell lung cancer often requires antiemetic premedication.
  • Ondansetron and dexamethasone are commonly used for nausea and vomiting prophylaxis.

Observation:

  • A patient receiving chemotherapy experienced transient neurological deficits, including altered mental status and right-sided weakness, after ondansetron administration.
  • A second episode with anisocoria, facial paresis, and dysarthria occurred, initially suspected as SIADH but rapidly resolved with biperiden.
  • These events mimicked cerebrovascular accidents despite negative brain imaging.

Findings:

  • The neurological symptoms were strongly associated with ondansetron administration, suggesting an adverse drug reaction.
  • Hyponatremia was noted, but rapid symptom reversal with biperiden pointed towards an ondansetron-induced anticholinergic effect or other neurotoxicity.
  • Discontinuation of ondansetron and metoclopramide resolved the symptoms and prevented recurrence.

Implications:

  • Clinicians must consider ondansetron's potential for neurological adverse effects that can mimic stroke.
  • Thorough medication review and differential diagnosis are essential in complex cancer patient presentations.
  • Awareness of ondansetron's neurotoxic potential can prevent misdiagnosis and ensure appropriate management.