Tahsildar H I, Remler B F, Creger R J, Cooper B W, Snodgrass S M, Tarr R W, Lazarus H M
Ireland Cancer Center, Department of Medicine, University Hospitals of Cleveland, Case Western Reserve University, Ohio 44106, USA.
J Neurooncol. 1996 Mar;27(3):241-50. doi: 10.1007/BF00165481.
Subacute encephalopathy developed in four patients within one to two months after undergoing high-dose chemotherapy and bone marrow transplantation or peripheral blood progenitor (stem) cell transplantation for breast cancer, acute myeloid leukemia, and non-Hodgkin's lymphoma. None of the patients had previously known neurologic disorders, central nervous tumor or infection. Two patients presented with generalized tonic, clonic seizures, and two with confusion and lethargy. In all patients lumbar puncture and CT scans of the brain were normal, while magnetic resonance imaging (MRI) demonstrated multifocal predominantly white matter lesions. Phenytoin therapy was given to the two patients with seizures and all four patients improved without specific therapeutic intervention. Repeat MRIs became normal within three months. We report a delayed and transient encephalopathy which appears to be a unique complication of high-dose cytotoxic chemotherapy. The corresponding brain lesions may not be appreciated on CT scans, suggesting an expanded role for MRI studies in patients who develop neurologic findings while undergoing high-dose cytotoxic therapy.
4例乳腺癌、急性髓细胞白血病和非霍奇金淋巴瘤患者在接受大剂量化疗及骨髓移植或外周血祖（干）细胞移植后1至2个月内发生亚急性脑病。所有患者既往均无已知的神经系统疾病、中枢神经肿瘤或感染。2例患者出现全身性强直阵挛发作，2例出现意识模糊和嗜睡。所有患者的腰椎穿刺和脑部CT扫描均正常，而磁共振成像（MRI）显示多灶性病变，主要位于白质。对2例癫痫发作患者给予苯妥英治疗，所有4例患者未经特殊治疗干预均有改善。重复MRI检查在3个月内恢复正常。我们报告了一种延迟性和短暂性脑病，它似乎是大剂量细胞毒性化疗的一种独特并发症。脑部CT扫描可能无法发现相应的脑病变，这表明MRI检查在接受大剂量细胞毒性治疗时出现神经系统症状的患者中具有更广泛的作用。
