title: Potentially reversible acute cerebellar toxicity associated with Minnelide.
abstract: OBJECTIVE
  Minnelide is an experimental antineoplastic agent that is currently the subject of a phase 1 clinical trial for the treatment of pancreatic and gastrointestinal malignancies. In this study, we documented two cases of reversible acute cerebellar toxicity (REACT) associated with Minnelide and compared its radiological manifestations with other cerebellotoxic agents.
  
  
  METHODS
  Both patients had histories of progressive metastatic cancer and participated in a phase 1 clinical trial with Minnelide. They had an MRI examination including T2WI, FLAIR and SWI, axial and coronal DWI, and ADC map on admission and follow up.
  
  
  RESULTS
  In each patient, the initial MRI demonstrated increased signal on FLAIR and restricted diffusion in the cerebellar cortex without involvement of deep cerebellar nuclei or supratentorial areas. The presenting symptoms and the majority of imaging findings resolved on follow up MRI.
  
  
  CONCLUSIONS
  To our knowledge, Minnelide has shown an uncommon radiologic pattern of isolated cerebellar cortical involvement compared to other causes of cerebellar toxicity. Since this is a new medication, physicians' familiarity with the presenting symptoms and its temporal association with the imaging findings is important.
authors.affiliation: Department of Radiology, Division of Neuroradiology, University of Minnesota, 420 Delaware St. SE, Minneapolis, MN, 55455, USA. skhanipo@umn.edu.
authors.forename: Sara
authors.identifier: http://orcid.org/0000-0002-9298-0071
authors.initials: S
authors.lastname: Khanipour Roshan
authors.affiliation: University of Minnesota Medical School, Minneapolis, MN, USA.
authors.forename: Anthony D
authors.initials: AD
authors.lastname: Spano
authors.affiliation: Department of Radiology, Division of Neuroradiology, University of Minnesota, 420 Delaware St. SE, Minneapolis, MN, 55455, USA.
authors.forename: Alexander M
authors.initials: AM
authors.lastname: McKinney
authors.affiliation: Department of Radiology, Division of Neuroradiology, University of Minnesota, 420 Delaware St. SE, Minneapolis, MN, 55455, USA.
authors.forename: David R
authors.initials: DR
authors.lastname: Nascene
mesh_terms: D002531:Cerebellum / Q000000981:diagnostic imaging* / Q000187:drug effects*; D017321:Clinical Trials, Phase I as Topic; D003110:Colonic Neoplasms / Q000188:drug therapy; D004224:Diterpenes; D004852:Epoxy Compounds; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010755:Organophosphates / Q000633:toxicity*; D010190:Pancreatic Neoplasms / Q000188:drug therapy; D010616:Phenanthrenes / Q000633:toxicity*
chemical_list: D004224:Diterpenes; D004852:Epoxy Compounds; D010755:Organophosphates; D010616:Phenanthrenes; C579022:14-O-phosphonooxymethyltriptolide disodium salt
keywords: Cerebellar cortex; Cerebellar toxicity; Diffusion weighted imaging; Minnelide; Reversible acute cerebellar toxicity