levoleucovorin and Aphasia

Stroke mimics, especially those involving chemotherapy related neurotoxicity, can confound the clinical diagnosis of acute stroke. Here we describe the case of a 63year-old male with a recent history of stage IIIC colon cancer who presented with confusion on the second day of modified FOLFOX6 (5-fluorouracil/oxaliplatin) chemotherapy and subsequently received alteplase, tissue plasminogen activator therapy (tPA), for presumed ischemic stroke. Magnetic resonance imaging scans after tPA administration did not reveal evidence of an infarction and the patients' neurological symptoms resolved completely after discontinuation of 5-fluorouracil (5-FU). Although this patient did not experience any side effects from tPA, fibrinolytic therapy may have been avoided with a better understanding of potential chemotherapy related adverse reactions. Our experience suggests that 5-FU induced reversible encephalopathy can present with acute stroke-like symptoms and emergency medicine personnel evaluating patients for tPA treatment should be aware of this differential diagnosis.

Topics: Antimetabolites, Antineoplastic; Antineoplastic Combined Chemotherapy Protocols; Aphasia; Brain Diseases; Colonic Neoplasms; Confusion; Diagnosis, Differential; Fibrinolytic Agents; Fluorouracil; Headache; Humans; Leucovorin; Magnetic Resonance Imaging; Male; Middle Aged; Organoplatinum Compounds; Stroke; Tissue Plasminogen Activator

To describe a patient with reversible posterior leukoencephalopathy syndrome following the administration of bevacizumab (Avastin), a monoclonal antibody against vascular endothelial growth factor.. Case report/literature review.. University hospital.. A 52-year-old man receiving chemotherapy for stage IV rectal carcinoma.. Clinical and radiographic evidence consistent with reversible posterior leukoencephalopathy syndrome was found following the administration of irinotecan hydrochloride, leucovorin calcium, and fluorouracil (FOLFIRI) regimen chemotherapy and bevacizumab.. Reversible posterior leukoencephalopathy syndrome following treatment with angiogenesis modulators can occur. In addition to raising clinical suspicion in appropriate patients, this report may yield clues to the pathophysiologic underpinnings of reversible posterior leukoencephalopathy syndrome.

Topics: Angiogenesis Inhibitors; Antibodies, Monoclonal; Antibodies, Monoclonal, Humanized; Antineoplastic Combined Chemotherapy Protocols; Aphasia; Bevacizumab; Blindness, Cortical; Blood Vessels; Camptothecin; Carcinoma; Cognition Disorders; Colonic Neoplasms; Dementia, Vascular; Fluorouracil; Humans; Leucovorin; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Neovascularization, Pathologic; Occipital Lobe; Parietal Lobe; Vascular Endothelial Growth Factor A

Topics: Adult; Aphasia; Drug Administration Schedule; Female; Hemiplegia; Humans; Leucovorin; Male; Methotrexate

Topics: Aphasia; Brain Neoplasms; Carotid Arteries; Cerebral Angiography; Drug Therapy; Glioma; Humans; Infusions, Intra-Arterial; Leucovorin; Methotrexate; Necrosis; Paralysis; Parietal Lobe; Surgical Procedures, Operative; Temporal Lobe