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Feige J, Klausner F, Pfaff JAR, Trinka E, Pikija S, Safdarian M. Stroke-like presentation of acute toxic leukoencephalopathy due to capecitabine treatment with extensive intramyelinic edema. Chronic Dis Transl Med 2023; 9:258-262. [PMID: 37711866 PMCID: PMC10497845 DOI: 10.1002/cdt3.72] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Revised: 04/27/2023] [Accepted: 05/11/2023] [Indexed: 09/16/2023] Open
Affiliation(s)
- Julia Feige
- Department of Neurology, Neurocritical Care and Neurorehabilitation, Centre of Cognitive Neuroscience, Christian Doppler University HospitalParacelsus Medical University, Salzburg, Member of EpiCARESalzburgAustria
| | - Fritz Klausner
- Department of Neuroradiology, Christian Doppler University HospitalParacelsus Medical UniversitySalzburgAustria
| | - Johannes A. R. Pfaff
- Department of Neuroradiology, Christian Doppler University HospitalParacelsus Medical UniversitySalzburgAustria
| | - Eugen Trinka
- Department of Neurology, Neurocritical Care and Neurorehabilitation, Centre of Cognitive Neuroscience, Christian Doppler University HospitalParacelsus Medical University, Salzburg, Member of EpiCARESalzburgAustria
- Neuroscience Institute, Christian‐Doppler University HospitalParacelsus Medical University, Centre for Cognitive NeuroscienceSalzburgAustria
- Institute of Public Health, Medical Decision‐Making and HTAUMIT ‐ Private University for Health Sciences, Medical Informatics and TechnologyHall in TyrolAustria
| | - Slaven Pikija
- Department of Neurology, Neurocritical Care and Neurorehabilitation, Centre of Cognitive Neuroscience, Christian Doppler University HospitalParacelsus Medical University, Salzburg, Member of EpiCARESalzburgAustria
| | - Mahdi Safdarian
- Department of Neurology, Neurocritical Care and Neurorehabilitation, Centre of Cognitive Neuroscience, Christian Doppler University HospitalParacelsus Medical University, Salzburg, Member of EpiCARESalzburgAustria
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Murthy VD, McLarty E, Woolard KD, Parker RL, Kortz G, King JN, Poppenga RH, Knipe MF, Dickinson PJ. Case Report: MRI, Clinical, and Pathological Correlates of Bromethalin Toxicosis in Three Dogs. Front Vet Sci 2022; 9:879007. [PMID: 35558887 PMCID: PMC9087846 DOI: 10.3389/fvets.2022.879007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 03/16/2022] [Indexed: 11/13/2022] Open
Abstract
Bromethalin toxicosis is an increasingly common clinical presentation in dogs that may be fatal depending on the extent of intoxication. Antemortem diagnosis of bromethalin toxicosis was achieved in three dogs by demonstration of the active metabolite desmethylbromethalin in fat or serum. Magnetic resonance imaging (MRI) findings were consistent with a diffuse leukoencephalopathy with restricted diffusion and prominent involvement of the corticospinal motor tracts on T2-weighted and diffusion-weighted sequences. Imaging findings were confirmed in one non-surviving dog at necropsy. Resolution of MRI abnormalities was demonstrated in one surviving dog that was consistent with the associated resolution of clinical signs. Initial findings in these dogs support further investigation of specific MRI patterns in cases of leukoencephalopathy to aid differential diagnosis. While antemortem detection of bromethalin and its metabolites confirms exposure, quantitation may be informative as a prognostic biomarker.
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Affiliation(s)
- Vishal D. Murthy
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Washington State University, Pullman, WA, United States
| | - Ehren McLarty
- Department of Surgical and Radiological Sciences, University of California, Davis, Davis, CA, United States
| | - Kevin D. Woolard
- Department of Pathology, Microbiology and Immunology, University of California, Davis, Davis, CA, United States
| | - Rell L. Parker
- Department of Small Animal Clinical Sciences, Virginia-Maryland Regional College of Veterinary Medicine, Virginia Polytechnic Institute and State University, Blacksburg, VA, United States
| | - Gregg Kortz
- Department of Neurology, VCA Sacramento Veterinary Referral Center, Sacramento, CA, United States
| | - Jamie N. King
- Department of Neurology, VCA Sacramento Veterinary Referral Center, Sacramento, CA, United States
| | - Robert H. Poppenga
- California Animal Health and Food Safety Laboratory System, University of California, Davis, Davis, CA, United States
| | - Marguerite F. Knipe
- Department of Surgical and Radiological Sciences, University of California, Davis, Davis, CA, United States
| | - Peter J. Dickinson
- Department of Surgical and Radiological Sciences, University of California, Davis, Davis, CA, United States
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Wagner-Altendorf TA, Heldmann M, Hanssen H, Münte TF. Permanent lesion to the corticospinal tract after therapy with capecitabine. BMJ Case Rep 2019; 12:12/9/e231248. [PMID: 31537598 DOI: 10.1136/bcr-2019-231248] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Capecitabine is an oral fluoropyrimidine used to treat solid tumours such as colorectal and breast cancer. A rare but severe side effect is capecitabine-induced leukoencephalopathy, including bilateral lesion to the corticospinal tract. However, neurological symptoms due to capecitabine treatment are usually reported to be reversible after discontinuation of capecitabine. Here, we present the case of a patient with bilateral degeneration of the corticospinal tract and progressive spastic tetraplegia after chemotherapy with capecitabine mimicking primary lateral sclerosis. Although therapy with capecitabine was ended, symptoms substantially worsened over the following years and the patient finally died from aspiration pneumonia almost 3 years after the application of capecitabine.
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Affiliation(s)
| | - Marcus Heldmann
- Department of Neurology, University Hospital Schleswig-Holstein, Lübeck, Germany
| | - Henrike Hanssen
- Department of Neurology, University Hospital Schleswig-Holstein, Lübeck, Germany
| | - Thomas F Münte
- Department of Neurology, University Hospital Schleswig-Holstein, Lübeck, Germany
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