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Rezidivierendes reversibles posteriores Leukenzephalopathiesyndrom unter Chemotherapie mit Cisplatin und 5-Fluorouracil

Relapsing reversible posterior leukoencephalopathy after chemotherapy with cisplatin and 5-fluorouracil

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Zusammenfassung

Wir berichten über einen 37-jährigen Patienten mit einem Magenkarzinom, der im Rahmen einer postoperativen Chemotherapie mit Cisplatin und 5-Fluorouracil zwei zeitlich getrennte Episoden mit Grand-mal-Anfällen entwickelte. In der cMRT fanden sich wiederholt vornehmlich postzentral und okzipital lokalisierte morphologische Veränderungen im Sinne einer Leukenzephalopathie, die nach den einzelnen Episoden reversibel waren. Ätiologisch ist ein chemotherapieassoziiertes, reversibles posteriores Leukenzephalopathiesyndrom (RPLS) anzunehmen, das ungewöhnlicherweise rezidivierend auftrat. Dieses seltene Syndrom hat als Differenzialdiagnostik zum bilateralen Posteriorinfarkt praktische Bedeutung für die Akutneurologie und wird anhand des Fallberichtes ätiologisch erörtert.

Summary

We report a 37-year-old patient with gastric cancer who suffered two distinct episodes of generalized tonic-clonic seizures during ongoing chemotherapy with cisplatin and 5-fluorouracil. Cranial MRI revealed reversible posterior leukoencephalopathy (RPL) that remitted completely without any specific therapy after discontinuation of the chemotherapeutic drugs. Interestingly, RPL occurred repeatedly in our patient following the single chemotherapy cycles, which has not been described so far. This syndrome is clinically relevant for differential diagnosis of bilateral ischemia of the posterior cerebral arteries. An overview of the literature and necessary diagnostic procedures is given.

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Authors and Affiliations

  1. Institut für Neuroimmunologie, Klinische und Experimentelle Neuroimmunologie, Charité — Universitätsmedizin Berlin

    F. Paul, O. Aktas & F. Zipp

  2. Klinik für Neurologie, Helios-Klinikum Berlin

    F.-J. Dieste, P. Kreitsch & H.-P. Vogel

  3. Institut für Neuroimmunologie, Klinische und Experimentelle Neuroimmunologie, Charité — Universitätsmedizin Berlin, 10098, Berlin, Deutschland

    F. Paul

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  1. F. Paul
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  2. O. Aktas
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  3. F.-J. Dieste
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  4. P. Kreitsch
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  5. H.-P. Vogel
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  6. F. Zipp
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Correspondence to F. Paul.

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Paul, F., Aktas, O., Dieste, FJ. et al. Rezidivierendes reversibles posteriores Leukenzephalopathiesyndrom unter Chemotherapie mit Cisplatin und 5-Fluorouracil. Nervenarzt 77, 706–710 (2006). https://doi.org/10.1007/s00115-006-2055-5

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  • DOI: https://doi.org/10.1007/s00115-006-2055-5

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