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Abstract Details

5-Fluorouracil Neurotoxicity in Patient Without Dihydropyrimidine Dehydrogenase Deficiency
Neuro Trauma, Critical Care, and Sports Neurology
Neurocritical Care Posters (7:00 AM-5:00 PM)
009
We report a rare and serious encephalopathy and seizure disorder associated with a commonly used chemotherapeutic agent, 5-fluorouracil. Our objective is to make clinicians aware of 5FU-related reversible neurotoxicity even in the absence of dihydropyrimidine dehydrogenase deficiency.

5-Fluorouracil is a commonly-used chemotherapeutic agent for the treatment of various solid malignancies including colon cancer. Common side effects include myelosuppression, nausea, vomiting, diarrhea, mucositis, and skin changes. Neurotoxicity is a rare side effect of 5FU administration and often manifests as confusion, agitation, ataxia, seizure, and coma. Dihydropyrimidine dehydrogenase (DPD) is an enzyme responsible for the breakdown of 5FU. Mutation in the DPD gene has been associated with increased risk of 5FU toxicity. 
NA

Case Presentation: We report a case of acute reversible neurotoxicity and refractory status epilepticus in a patient with colorectal adenocarcinoma being treated with leucovorin calcium, 5-fluorouracil and oxaliplatin (FOLFOX) in the absence of DPD deficiency. The patient received uridine triacetate, the antidote for 5FU toxicity. MRI of the brain demonstrated multifocal areas of restricted diffusion which resolved on day ten of uridine treatment.

Clinicians should consider 5FU neurotoxicity in the differential diagnosis of a patient on 5FU chemotherapy who presents with acute unexplained encephalopathy or status epilepticus.
Authors/Disclosures
Rebecca Jules, MD
PRESENTER 		Dr. Jules has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Crexont.
William H. Roth, MD (New York Presbyterian Hospital, Columbia) No disclosure on file
Katharina M. Busl, MD, MS, FÂ鶹´«Ã½Ó³»­ (University of Florida) Dr. Busl has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Rissman Law. Dr. Busl has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Huffman Powell Baley. Dr. Busl has received personal compensation in the range of $500-$4,999 for serving as a Consultant for University Science. Dr. Busl has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for SCCM. Dr. Busl has a non-compensated relationship as a Board Member with Art in Medicine that is relevant to Â鶹´«Ã½Ó³»­ interests or activities. Dr. Busl has a non-compensated relationship as a Associate Editor with Critical Care Explorations that is relevant to Â鶹´«Ã½Ó³»­ interests or activities. Dr. Busl has a non-compensated relationship as a Assistant Editor with Neurocritical Care that is relevant to Â鶹´«Ã½Ó³»­ interests or activities.
Pouya A. Ameli, MD (University of Florida, Dept of Neurology, Div of Neurocritical Care) Dr. Ameli has received personal compensation in the range of $500-$4,999 for serving as a Contributor/Presenter with MedStudy. Dr. Ameli has a non-compensated relationship as a Board of Trustees with Neurocritical Care Foundation that is relevant to Â鶹´«Ã½Ó³»­ interests or activities.
Christopher P. Robinson, DO (University of Florida Department of Neurology) Dr. Robinson has received personal compensation in the range of $5,000-$9,999 for serving as an Expert Witness for law firms.
Marc Alain Babi, MD (Cleveland Clinic Foundation (Florida Region)) Dr. Babi has nothing to disclose.
William Roth, MD (University of Chicago) William Roth has nothing to disclose.