Organic Mental Changes With Fluorouracil Therapy

Abstract

To the Editor.— Two patients showed a rapid and dramatic change in their mental status within a few weeks to two months of the start of weekly intravenous fluorouracil chemotherapy for colon cancer with liver metastases. The first patient was a 70-year-old man who after two months of fluorouracil therapy had no evidence of focal central nervous system disease but was confused and had marked psychomotor retardation and slight lethargy. Brain scan was normal, while the electroencephalogram showed diffuse slow wave activity. The second patient was an 80-year-old widowed woman who was mildly depressed but had no impairment of mental ability when admitted to the hospital. After three weekly doses of fluorouracil intravenously, mild confusion was noted, which progressed to semicoma. Findings of neurologic examination were normal except for a severely confused mental state characterized by total disorientation as to time and place as well as by inappropriate answers to