Department of Neurology and Clinical Neurophysiology, Hannover Medical School, 30623 Hannover, Germany.
J Neurooncol. 2011 May;103(1):163-6. doi: 10.1007/s11060-010-0354-y. Epub 2010 Aug 22.
Temozolomide in combination with radiation has been in use for more than 5 years for the therapy of glioblastoma. Known adverse effects concerning the gastrointestinal system are elevation of liver enzymes. We present the case of a patient treated with temozolomide who developed severe cholestatic liver damage and consecutive hepatic encephalopathy. Neurological symptoms were mistaken as being caused by focal brain damage for more than 9 months. After the correct diagnosis had been made and the treatment had been started, the patient's condition ameliorated. In conclusion, neurological deficits in patients with known brain lesion should not be attributed automatically to the pre-existing damage even if it is progressive but should be examined carefully, also including toxic and metabolic encephalopathies into the differential diagnosis. Furthermore, new side effects of drugs have to be considered. At least this case might lead to a closer monitoring of liver enzymes during temozolomide therapy.
替莫唑胺联合放疗已用于胶质母细胞瘤治疗超过 5 年。已知的胃肠道系统不良反应为肝酶升高。我们报告了 1 例替莫唑胺治疗后发生严重胆汁淤积性肝损伤和肝性脑病的病例。神经症状在 9 个多月的时间里被误认为是由局灶性脑损伤引起的。在做出正确诊断并开始治疗后，患者的病情有所改善。总之，对于已知有脑损伤的患者，即使病变在进展，神经缺损也不应自动归因于先前的损伤，而应仔细检查，将中毒性和代谢性脑病也纳入鉴别诊断。此外，还需要考虑新的药物副作用。至少该病例可能会导致在替莫唑胺治疗期间更密切地监测肝酶。
