CEREBRAL DEMYELINATION SYNDROME IN A PATIENT TREATED WITH 5-FLUOROURACIL AND LEVAMISOLE - THE USE OF THALLIUM SPECT IMAGING TO ASSIST IN NONINVASIVE DIAGNOSIS - A CASE-REPORT

BACKGROUND, The use of ij-fluorouracil (5-FU) and levamisole in patien ts with Stage III adenocarcinoma of the colon has now become standard. There have been several reports of a multifocal cerebral demyelinatio n syndrome following 5-FU and levamisole administration. METHODS. We d escribe a patient who developed focal neurologic symptoms while being treated with levamisole and 5-FU in whom the diagnosis of central nerv ous system (CNS) metastases was considered. RESULTS, A magnetic resona nce imaging (MRI) scan showed a diffuse, multifocal white matter proce ss. Diagnostic evaluation did not support a diagnosis of CNS metastasi s. (201)Thallium chloride single photon emission computed tomography ( SPECT) study was cold. A stereotactic brain biopsy disclosed demyelina tion but not tumor. The patient had complete functional resolution of symptoms with 1 month of dexamethasone therapy, although follow-up MRI scans have shown persistent abnormality on T2-weighted images. CONCLU SIONS, In patients receiving 5-FU and levamisole who develop focal neu rologic symptoms with an abnormal MRI scan, the diagnosis of CNS metas tasis should not be made without a thorough diagnostic evaluation. We suggest the use of (201)thallium chloride SPECT imaging to support the diagnosis of multifocal leukoencephalopathy related to 5-FU and levam isole. In atypical cases, a stereotactic brain biopsy may be required for confirmation. (C) 1996 American Cancer Society.