Neuraxonal dystrophy of the brain in patients receiving antineoplastic chemotherapy

The present report describes the neuropathological change found in the brainstem of four patients who were treated with combined chemotherapy for various types of malignant disease. The change consists of localized axonal swellings, the so-called "axonal spheroids" located predominantly in the medial lemniscus, the fibers from the olivary nuclei and around some of the cranial nerve nuclei. In addition to the brain change, all four patients had shown histological evidence of hepatic injury, although none of the patients exhibited overt clinical or chemical evidence of hepatic insufficiency. Neither did these patients show any clinical neurological deficit that could be related to the pathological findings. The neuroaxonal changes are most likely the result of altered metabolism as a consequence of the chemotherapy.