Acute cerebellar syndrome following intermediate‐dose cytarabine

Abstract

A 64-year-old patient with stage II B-large-cell non-Hodgkin's lymphoma obtained complete remission after CHOP (cyclophosphamide, hydroxydoxorubicin, vincristine, prednisone) chemotherapy. Early localized relapse was treated by DHAP chemotherapy (cisplatin 100 mg/m2 d 1, cytarabine 2 g/m2 d 2, dexamethasone 40 mg/m2 d 1–4) followed by complete lymph node regression. A month later, 3 d after a second DHAP, the patient developed acute cerebellar syndrome manifested by gait ataxia, nystagmus, lack of co-ordination and dysarthria. Consecutive lumbar punctures were normal. Magnetic resonance imaging (MRI) of the brain revealed bilateral diffuse cerebellar high-intensity lesions on T2 (left panel) and hypointensity signal on T1 (right panel) without enhancement after gadolinium injection, consistent with cytarabine neurotoxicity, and no signs of a tumour mass. Six months later, the patient remains in complete remission, still without neurological improvement, and MRI shows no modifications. Risk factors for cytarabine neurotoxicity are: age over 50 years, male sex, high drug dose, renal and hepatic dysfunction and past history of neurological dysfunction. Although cytarabine-induced neurotoxicity is common after doses in the range of 36 g/m2, rare cases of severe neurotoxicity after doses as low as 0·5 g/m2 have been reported in patients with renal insufficiency.