Ferroir J P, Fenelon G, Beaugerie L, Avenin Recoing D
Service de Neurologie, Hôpital Ténon, Paris.
Rev Neurol (Paris). 1994 Jun-Jul;150(6-7):471-4.
Two female patients with an adenocarcinoma of the colon (Duke stages B and C) underwent colectomy followed by adjuvant chemotherapy combining 5 fluorouracil (5 FU) and levamisole. Secondary neurological manifestations occurred in both patients including vertigo, nausea and vomiting, dizziness with loss of balance, slow ideation, impaired memory, headache and, on one case, central origin facial paralysis. Symptoms appeared between the 11th and 34th week of treatment. The patients had received 9 to 30 g 5 FU and 2.7 to 7.6 g levamisole. CT scan and/or MRI first suggested cerebral metastases then demyelinisation. The clinical signs disappeared spontaneously in less than one month. The brain images were unchanged. The 5 FU/levamisole combination was undoubtedly responsible for the neurological manifestations. Levamisole may have potentialized the effect of 5 FU leading to demyelinisation. Whether chemotherapy should be stopped or not is debated.
两名患有结肠癌（杜克分期B和C期）的女性患者接受了结肠切除术，随后进行了5-氟尿嘧啶（5-FU）和左旋咪唑联合辅助化疗。两名患者均出现了继发性神经表现，包括眩晕、恶心和呕吐、平衡失调伴头晕、思维迟缓、记忆力减退、头痛，其中一例出现中枢性面瘫。症状出现在治疗的第11至34周之间。患者接受了9至30克5-FU和2.7至7.6克左旋咪唑。CT扫描和/或MRI最初提示脑转移，然后提示脱髓鞘。临床症状在不到一个月内自发消失。脑部图像未改变。5-FU/左旋咪唑联合用药无疑是导致神经表现的原因。左旋咪唑可能增强了5-FU的作用，导致脱髓鞘。是否应停止化疗存在争议。
