title: Capecitabine-induced leukoencephalopathy involving the bilateral corticospinal tracts.
abstract: An 80 year old lady with a history of metastatic sigmoid carcinoma presented with expressive dysphasia and unsteady gait 4 days after commencement of adjuvant capecitabine chemotherapy. MRI demonstrated restricted diffusion and T2/FLAIR hyperintensity involving the course of the bilateral corticospinal tracts, the corpus callosum and the middle cerebellar peduncles. Discontinuation of chemotherapy lead to symptom resolution in 2 days; repeat MRI at 2 months demonstrated reversal of the diffusion changes and improvement of the previous T2W/FLAIR hyperintensity. This report describes the first case of capecitabine induced leukoencephalopathy causing restricted diffusion along the corticospinal tracts, which should be differentiated from other entities that involve the corticospinal tracts (i.e. amyotrophic lateral sclerosis (ALS), primary lateral sclerosis (PLS), hypoglycemic coma, etc.).
authors.affiliation: Department of Diagnostic Radiology, Singapore General Hospital, Singapore.
authors.forename: Mark Bang-Wei
authors.initials: MB
authors.lastname: Tan
authors.affiliation: Department of Diagnostic Radiology, Singapore General Hospital, Singapore.
authors.forename: Louis Elliott
authors.initials: LE
authors.lastname: McAdory
mesh_terms: D000369:Aged, 80 and over; D000964:Antimetabolites, Antineoplastic / Q000009:adverse effects*; D000069287:Capecitabine / Q000009:adverse effects*; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D056784:Leukoencephalopathies / Q000139:chemically induced*; D008279:Magnetic Resonance Imaging; D011712:Pyramidal Tracts / Q000187:drug effects*; D012811:Sigmoid Neoplasms / Q000188:drug therapy / Q000473:pathology; D014057:Tomography, X-Ray Computed
chemical_list: D000964:Antimetabolites, Antineoplastic; D000069287:Capecitabine
keywords: Capecitabine induced leukoencephalopathy; capecitabine toxicity; corpus callosum; corticospinal tracts; drug-induced leukoencephalopathy