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Malignant Gliomas in Adults 

Stereotactic Radiosurgery for the Management of Brain Metastases 
Central Nervous System Tumors (Mayo Clinic Proced) 
Paraneoplastic Syndromes Involving the Nervous System 

Neurological Complications of Cancer Treatment



Case Discussion


56 yo F with rectal and colon cancer, metastatic comes with AMS 5 days after first round of cisplatin and 5-flurouracil treatment. 3 days later has AMS and is being admitted for further evaluation. 

What is the DDx? 
  • Infection (viral and bacterial are possibility - fever may be masked by chemo and steroids), 
  • Metabolic (leucoencephalopathy is associated with use of Cisplatin), 
  • CVA with ischmia or venous thrombosis, 
  • Seizures, 
  • Septic encephalopathy
MRI was concerning for ischemia in pons, cerebellum. 

3 days later, patient starts to improve, and wakes up. 

What is the Diagnosis.

Not sepsis, Seizure, Infection as MRI findings will not be consistent. The diagnosis is Cisplatin induced leucoencephalopathy - PRES. 

What is PRES?

What is the pathogenesis of PRES?
  • auto regulatory failure 
  • cerebral ischemia
  • endothelial dysfunction

Also, Patient also has AKI. DDx?
  • Infection causing pre renal 
  • Cisplatin induced kidney injury
Work up revealed patient has Ur Cr of 34 and U Na of 85. Fena > 4. This is likely Renal Injury due to Cisplatin.