The Teaching Point

Capecitabine, an oral chemotherapeutic agent, uncommonly causes leukoencephalopathy that presents as diffusion/T2W/FLAIR abnormalities of the cerebral white matter in varied patterns, including that of the bilateral corticospinal tracts. This disease entity should thus be considered in the differential diagnosis of leukoencephalopathy involving the corticospinal tracts.






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From the manuscript

Capecitabine-induced leukoencephalopathy involving the bilateral corticospinal tracts

Free full text article: Capecitabine-induced leukoencephalopathy  involving the bilateral corticospinal tracts

Abstract
An 80 year old lady with a history of metastatic sigmoid carcinoma presented with expressive dysphasia and unsteady gait 4 days after commencement of adjuvant capecitabine chemotherapy. MRI demonstrated restricted diffusion and T2/FLAIR hyperintensity involving the course of the bilateral corticospinal tracts, the corpus callosum and the middle cerebellar peduncles. Discontinuation of chemotherapy lead to symptom resolution in 2 days; repeat MRI at 2 months demonstrated reversal of the diffusion changes and improvement of the previous T2W/FLAIR hyperintensity. This report describes the first case of capecitabine induced leukoencephalopathy causing restricted diffusion along the corticospinal tracts, which should be differentiated from other entities that involve the corticospinal tracts (i.e. amyotrophic lateral sclerosis (ALS), primary lateral sclerosis (PLS), hypoglycemic coma, etc.)






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