Neurology病例：5-Fu诱发急性白质脑病

一位55岁的乙状结肠癌患者（氟尿嘧啶[5-Fu]，累积剂量6600毫克/平方米；奥沙利铂：245毫克/平方米），在接受第三个周期化疗2周后出现脑病和泛脑贝勒受累。脑MRI显示双侧深白质、小脑足和胼胝体脾脏的扩散受限（图1和图2），提示有5-Fu诱发的白质脑病。药物性脑病患者停止化疗后症状有所改善1.由于后皮质下白质通常累及后皮质下白质，因此对PRES（后可逆性脑病综合征）的诊断似乎不太可能。磁共振弥散加权成像是早期发现这一特征性脑病的一种有效方法

图1颅脑弥散加权MRI显示（a）胼胝体压部弥散受限，（b）深部白质弥散受限。

图2（A）脑MRI中的扩散限制涉及双边小脑脚（B）和在双边和脑室旁深部白质和小脑脚的T2高信号。

英文原文：

5-FU–induced acute leukoencephalopathy

A 55-year-old man with carcinoma sigmoid colon(fluorouracil [5-FU]: cumulative dose of 6,600 mg/m2; and oxaliplatinum: 245mg/m2) presented with encephalopathy and pancerebellar involvement 2 weeksafter receiving a third cycle of chemotherapy. Brain MRI showed diffusionrestriction in bilateral deep white matter, cerebellar peduncles, and spleniumof corpus callosum (figures 1 and 2) suggestive of 5-FU–inducedleukoencephalopathy. Symptoms improved after discontinuation of chemotherapy asexpected in drug-induced encephalopathy.1 Diagnosis of PRES (posteriorreversible encephalopathy syndrome) seemed less likely because it usuallyinvolves posterior subcortical white matter. Diffusion-weighted MRI is a usefulmodality for early detection of this characteristic encephalopathy.

al white matter. Diffusion-weighted MRI is a usefulmodality for early detection of this characteristic encephalopathy.

FIGURE 1  Cranial diffusion-weighted MRI showingdiffusion restriction in (A) splenium of corpus callosum and (B) deep whitematterS.

FIGURE 2 CRANIALMRI (A) DIFFUSION RESTRICTION INVOLVING BILATERAL MIDDLE CEREBELLAR PEDUNCLESAND (B) T2 HYPERINTENSITIES IN BILATERAL PERIVENTRICULAR AND DEEP WHITE MATTERAND MIDDLE CEREBELLAR PEDUNCLES.