title: Clinical and radiological features of brain neurotoxicity caused by antitumor and immunosuppressant treatments.
abstract: Antitumor and immunosuppressant treatment-related neurotoxicity can determine nonspecific clinical syndromes. Exclusion of other possible causes, among which tumor progression, appearance of paraneoplastic disease, renal or hepatic failure, diabetes or hypertension, is relevant. We report clinical and neuroradiological features in five patients with neurotoxic syndromes due to chemotherapy/radiotherapy or immunosuppression in the context of neoplastic disease/organ transplantation. Acute neurological syndrome developed in three patients after methotrexate (MTX), cyclosporine A, and L-asparaginase therapy, respectively. MRI showed posterior reversible encephalopathy in two cases and venous thrombosis with intraparenchymal hematoma in the third patient. Late onset clinical syndrome occurred in the last two patients, treated with MTX or radiation therapy for breast cancer metastasis and pituitary adenoma. Neuroimaging showed brain diffuse abnormalities. Patients affected by tumors suffer from increased risk for treatment-related toxicities. Appearance or worsening of neurological signs and symptoms challenge the clinician to discriminate between CNS involvement by the tumor, toxicity of drugs, parane-oplastic disease and infections. MRI has a key role in differential diagnosis. Close interaction between the neurologist, the oncologist and the neuroradiologist leads to the optimal management of patients.
authors.affiliation: Department of Neuro-Oncology, Fondazione IRCCS Istituto Neurologico C Besta, Milan, Italy. aerbetta@istituto-besta.it
authors.forename: Alessandra
authors.initials: A
authors.lastname: Erbetta
authors.forename: Andrea
authors.initials: A
authors.lastname: Salmaggi
authors.forename: Angelo
authors.initials: A
authors.lastname: Sghirlanzoni
authors.forename: Antonio
authors.initials: A
authors.lastname: Silvani
authors.forename: Paolo
authors.initials: P
authors.lastname: Potepan
authors.forename: Andrea
authors.initials: A
authors.lastname: Botturi
authors.forename: Elisa
authors.initials: E
authors.lastname: Ciceri
authors.forename: Maria Grazia
authors.initials: MG
authors.lastname: Bruzzone
mesh_terms: D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000009:adverse effects*; D001215:Asparaginase / Q000009:adverse effects; D001921:Brain / Q000187:drug effects* / Q000473:pathology* / Q000503:physiopathology; D002550:Cerebral Veins / Q000187:drug effects / Q000473:pathology / Q000503:physiopathology; D002648:Child; D016572:Cyclosporine / Q000009:adverse effects; D003937:Diagnosis, Differential; D005260:Female; D006084:Graft Rejection / Q000188:drug therapy; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D016031:Liver Transplantation / Q000009:adverse effects; D008279:Magnetic Resonance Imaging; D008297:Male; D008727:Methotrexate / Q000009:adverse effects; D008875:Middle Aged; D009369:Neoplasms / Q000601:surgery / Q000628:therapy; D020258:Neurotoxicity Syndromes / Q000473:pathology* / Q000503:physiopathology; D020361:Paraneoplastic Syndromes, Nervous System / Q000175:diagnosis; D011878:Radiotherapy / Q000009:adverse effects; D012307:Risk Factors; D020246:Venous Thrombosis / Q000139:chemically induced
chemical_list: D000970:Antineoplastic Agents; D007166:Immunosuppressive Agents; D016572:Cyclosporine; D001215:Asparaginase; D008727:Methotrexate