1/23. Spinal epidural abscess complicating chronic epidural analgesia in 11 cancer patients: clinical findings and magnetic resonance imaging.We reviewed the records of all patients who had received an epidural catheter for management of chronic cancer pain in a 3-year period (1993-1996). patients with nervous system infections were identified, and pertinent clinical, radiological (magnetic resonance imaging), and bacteriological data were analyzed. We identified 11 patients who developed spinal epidural abscess (SEA). All of these had back pain; radicular signs occurred in seven patients and spinal cord compression in two patients. magnetic resonance imaging revealed SEA in all 11 patients. SEA was iso- to hypointense on T1-weighted images and hyperintense on T2-weighted images relative to spinal cord. After gadolinium administration seven lesions showed characteristic rim enhancement while three showed minimal enhancement. No signs of diskitis or osteomyelitis were present, and the abscess was always localized to the posterior epidural space. Cultures were positive in all cases and revealed staphylococcus epidermidis in eight and S. aureus in three. All patients were treated with intravenous antibiotics, and four had an additional decompressive laminectomy. Two patients died within 1 week of diagnosis from overwhelming septicemia despite apparently adequate antibiotic treatment. Within 4 weeks after diagnosis of SEA two patients died from widely metastatic disease, although infection may have contributed. One patient developed septicemia while receiving appropriate antibiotics and underwent emergency laminectomy. The neurological deficits recovered in all patients who survived the acute infectious episode. We conclude that patients with chronic epidural catheters for cancer pain require prompt neurological evaluation and magnetic resonance imaging when SEA is suspected. Early evaluation and treatment may lead to full recovery.- - - - - - - - - - ranking = 1keywords = nervous system (Clic here for more details about this article) |
2/23. methylene blue in the treatment and prevention of ifosfamide-induced encephalopathy: report of 12 cases and a review of the literature.ifosfamide is an alkylating agent used in the treatment of a variety of solid tumours. Ten to 15% of patients treated with ifosfamide develop an encephalopathy. methylene blue (MB) may be used in the treatment of this encephalopathy. The purpose of this study was to evaluate the neuroprotective effect of MB in these patients and to review the literature. Between 1993 and 1997, 52 patients (age 16-77 years) with solid tumours were treated with ifosfamide in dosages ranging from 3 to 5 g m(-2) q3w when given in combination schedules and up to 12 g m(-2) q4w when given as a single agent. Twelve patients developed central nervous system (CNS) depression, defined as National Cancer Institute Common Toxicity Criteria (NCI-CTC) neurocortical toxicity grade 2 or higher. Eight were treated with MB at a dose of 6 x 50 mg day(-1) intravenously (i.v.). Four recovered fully within 24 h, two recovered partially after 24 h and completely after 48 h while two recovered only after 72 h. Four patients did not receive MB and all recovered only after 48 h. Three patients received prophylaxis with MB at a dose of 4 x 50 mg day(-1) i.v. for the subsequent chemotherapy cycles. Two developed milder encephalopathy; one had no CNS depression at all. We conclude that MB is an effective treatment for ifosfamide-induced encephalopathy. Our findings suggest that it may also be used as a prophylactic agent.- - - - - - - - - - ranking = 3.5477402668437keywords = central nervous system, nervous system (Clic here for more details about this article) |
3/23. Cerebral embolism, marantic endocarditis, and cancer.Two subjects with cerebral embolism were found at autopsy to have marantic (nonbacterial thrombotic) endocarditis (NBTE) and an unsuspected carcinoma. A additional 16 subjects with marantic endocarditis and cancer were found on reviewing the autopsy records of 22 subjects with NBTE. Of these 18 subjects with NBTE and cancer, eight developed a stroke during their illness, in five as the initial manifestation of cancer. Although the association of cancer and marantic endocarditis is generally well recognized, cerebral embolism from this source should be more seriously considered as one of the "remote effects" of cancer on the nervous system.- - - - - - - - - - ranking = 1keywords = nervous system (Clic here for more details about this article) |
4/23. cisplatin-induced encephalopathy and seizures.cisplatin induces mainly a peripheral sensory neuropathy, but occasionally may also induce an encephalopathy with or without seizures. We describe the clinical signs and symptoms of cisplatin encephalopathy. The clinical events in three patients that developed seizures and encephalopathy with focal signs are described. Two patients completely recovered, one patient developed a focal status epilepticus, refractory to antiepileptic treatment, and died due to ongoing seizures. Post-mortem examination of the central nervous system in this patient showed an ischemic lesion in the left temporal area and mild gliosis of the white matter. One patient was rechallenged with cisplatin after which he developed a second episode of encephalopathy. We conclude that physicians using cisplatin chemotherapy should be aware of this rare complication.- - - - - - - - - - ranking = 3.5477402668437keywords = central nervous system, nervous system (Clic here for more details about this article) |
5/23. High-dose radiation-induced meningiomas. Report of five cases and critical review of the literature.radiotherapy is an important modality for the treatment of tumors and arteriovenous malformations affecting the central nervous system, even though several significant side effects have been described (radionecrosis, tumors, etc.). Meningiomas induced by high-dose radiation therapy are uncommon. In this study we describe five cases treated at our institute and review all previously published reports of meningioma occurring after high-dose radiotherapy. These tumors develop mainly in patients irradiated in childhood; their incidence peaks in the second decade of life, there is a predominance in females and a high frequency of malignant forms. Although rare, meningiomas may represent a late complication of radiation treatment. The behavior of the radiation-induced variety of meningioma seems to differ from that of its "spontaneous" counterpart. The use of radiotherapy should be carefully evaluated for relatively benign or congenital lesions which generally affect young patients with a long life expectancy.- - - - - - - - - - ranking = 3.5477402668437keywords = central nervous system, nervous system (Clic here for more details about this article) |
6/23. Chemotherapy-induced toxic leukoencephalopathy causes a wide range of symptoms: a series of four autopsies.We have observed an increasing number of autopsies on patients with chemotherapy-related complications. One complication is toxic leukoencephalopathy, which is due to a direct toxic effect of chemotherapeutic agents on the central nervous system white matter. Autopsies of four cases of toxic leukoencephalopathy were performed following standard protocols. The brain and spinal cord were examined routinely, and histological sections were taken for evaluation. We report here three patients with hematologic malignancies and one patient with metastatic carcinoma with chemotherapy-induced leukoencephalopathy. The first was a 56-year-old male treated with multiple chemotherapeutics for multiple myeloma. He presented with confusion and focal seizures with a rapid progression to coma and decerebrate posturing. The second was a 36-year-old male who developed mental status changes, ataxia and dysarthria following treatment for lymphoma. The third was a 16-year-old male who developed a profound peripheral and central neuropathy after chemotherapy treatment for T-cell acute lymphoblastic leukemia. The fourth was a 49-year-old female patient who was treated with multiple chemotherapeutics for Stage II breast carcinoma and subsequently developed visual acuity and field defects. The neuropathologic findings in these cases, although similar, varied in severity and distribution. The white matter was affected by severe myelin pallor, edema, and a prominent macrophage infiltrate in each of the cases. The location and extent of the central nervous system pathology correlated with the type and severity of clinical symptoms. These four cases, with their varied presenting symptoms, clinical courses, and degree of pathology, emphasize the importance of considering toxic leukoencephalopathy as an etiology of acute neurologic deterioration following high-dose chemotherapy.- - - - - - - - - - ranking = 7.0954805336873keywords = central nervous system, nervous system (Clic here for more details about this article) |
7/23. Neuropathological findings after continuous intrathecal administration of S( )-ketamine for the management of neuropathic cancer pain.Questions have been raised about the potential neurotoxicity of the neuraxial use of ketamine although ketamine and its active enantiomer S( )-ketamine have been used intrathecally and epidurally (caudally) for the management of perioperative pain and in a variety of chronic pain syndromes. Clinical experience following neuraxial administration of S( )-ketamine has been documented without reference to local central nervous system toxicity following this approach. In addition, there are no preclinical safety data regarding stability, compatibility, and neurotoxicity on intrathecal use of single S( )-ketamine or combinations of S( )-ketamine, morphine, bupivacaine, and clonidine. In the present case, the continuous intrathecal administration of S( )-ketamine, in combination with morphine, bupivacaine, and clonidine resulted in adequate pain relief in a patient suffering from intractable neuropathic cancer pain. However, postmortem observation of the spinal cord and nerve roots revealed severe histological abnormalities including central chromatolysis, nerve cell shrinkage, neuronophagia, microglial upregulation, and gliosis. Based on our results, neuraxial administration of S ( )-ketamine cannot be recommended for clinical practise before a systematic study of toxicology of neuraxial S( )-ketamine in animals or humans has been performed.- - - - - - - - - - ranking = 3.5477402668437keywords = central nervous system, nervous system (Clic here for more details about this article) |
8/23. Mental neuropathy (numb chin syndrome). A harbinger of tumor progression or relapse.The authors report four patients whose initial symptom of tumor recurrence or progression was unilateral numbness of the chin. Two patients had Hodgkin lymphoma, one had malignant melanoma, and one had prostate cancer. physical examination was notable only for unilateral anesthesia of the chin and lower lip. Diagnostic evaluation, including computed tomography (CT) scan and magnetic resonance imaging (MRI) of the brain, plain radiographs of the mandible, and cerebrospinal fluid analysis for protein, glucose, and cytology were normal. Bone scans revealed osseous lesions in the axial skeleton of all patients, whereas only two patients had abnormal uptake in the mandible. The authors conclude that in the setting of a negative evaluation for central nervous system (CNS) or local mandibular disease, mental neuropathy is associated with recurrent or progressive skeletal disease. In addition, to document relapsed or progressive cancer, the skeletal system may have to be examined at sites distant from the mandible.- - - - - - - - - - ranking = 3.5477402668437keywords = central nervous system, nervous system (Clic here for more details about this article) |
9/23. Nonconvulsive status epilepticus due to ifosfamide.OBJECTIVE: To report 2 cases of nonconvulsive status epilepticus (NCSE) following infusion of ifosfamide. CASE SUMMARIES: Two patients who received ifosfamide-containing chemotherapy developed NCSE. One woman received ifosfamide 1000 mg/m2 (1 h infusion on days 1-5); confusion, lethargy, and speech deterioration developed on day 3. The second patient developed similar symptoms on day 3 of treatment with 2500 mg/m2. Both patients responded to intravenous administration of diazepam 10 mg and were given levetiracetam as maintenance therapy. DISCUSSION: The severity and presentation of central nervous system toxicity due to ifosfamide varies greatly and involves a spectrum ranging from subclinical electroencephalogram changes to coma. NCSE, an epileptic disorder in which typical convulsive activity is absent, has previously been reported in only 4 patients receiving ifosfamide. Levetiracetam may be used for maintenance antiepileptic therapy after diazepam administration. CONCLUSIONS: Among the many presentations of ifosfamide neurotoxicity, clinicians should consider NCSE as a possible explanation for changes in consciousness in a patient receiving this agent. An objective causality assessment by use of the Naranjo probability scale revealed that NCSE due to ifosfamide was probable.- - - - - - - - - - ranking = 3.5477402668437keywords = central nervous system, nervous system (Clic here for more details about this article) |
10/23. acupuncture treatment for chemotherapy-induced peripheral neuropathy--a case series.Chemotherapy induced peripheral neuropathy (CIPN) occurs in 10 to 20% of cancer patients treated with neurotoxic chemotherapy. A mixture of sensory, sensorimotor and autonomic nervous system dysfunction can occur, resulting in deterioration in function and worsened quality of life. A major feature is discomfort and pain. Early termination of treatment and dose reduction of chemotherapy may be necessary. The clinical course is variable and depends on the chemotherapy agents and their cumulative dose. Although symptoms can resolve completely, in most patients CIPN is either only partially reversible or completely irreversible. Current management for CIPN is symptomatic using membrane stabilising medications and antidepressants. The use of nerve growth factors is still experimental. Dysaesthesia and pain involving the feet and hands are described in both traditional Chinese medicine (TCM) and Western biomedicine. In TCM, the pathogenesis is related to the inability to direct qi and blood to the extremities, and is associated with qi, blood, Yang and kidney deficiencies. acupuncture is moderately effective in treating diabetic neuropathy. However, to date, there is no report of the usefulness of acupuncture for CIPN. We report the result of a pilot prospective case series of five patients treated with an acupuncture protocol that aims to correct qi, blood and Yang deficiencies and directs qi and blood to the extremities, with the goal of improving the symptoms of CIPN. The responses were encouraging, and cannot be easily explained by the known neurophysiological mechanisms of acupuncture.- - - - - - - - - - ranking = 1keywords = nervous system (Clic here for more details about this article) |
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