Capecitabine induced multifocal leukoencephalopathy

Videnovic et al. Capecitabine-induced multifocal leukoencephalopathy: A report of five cases. Neurology 2005; 65:1792-94.

5 FU is used to treat breast and colon cancer and can cause a cerebellar syndrome or rarely, an encephalopathy. Capecitabine, an oral prodrug converted to 5FU is used in advanced breast and GI malignancies (including pancreatic or colon).

All 5 patients were women 40-74 started on capecitabine 2 g/msquared and within seven days developed neurologic symptoms requiring evaluation (range 3-7 days). They included nausea, confusion, short term memory loss, HA , vertigo, ataxia, dysarthria, and body shaking. MRI showed increased signal in brachium pontis, corpus callosum, deep periventricular area and SPLENIUM OF CORPUS CALLOSUM IN ALL CASES. The lesion was nonenhancing. Neurologic status improved with discontinuation of the drug.