Cancer Res Treat.  2015 Apr;47(2):329-333. 10.4143/crt.2013.145.

Reversible Cerebellar Ataxia Related to Extrapontine Myelinolysis without Hyponatremia after Cisplatin-Based Chemotherapy for Cholangiocarcinoma

• Chung JH
• Baik SK
• Cho SH
• Kim SG

• KMID: 2132813
• DOI: http://doi.org/10.4143/crt.2013.145

Abstract

A 60-year-old woman presented with cerebellar signs including dysarthria and ataxia, after intravenous infusion of cisplatin-based chemotherapy. Several blood tests showed mild neutropenia, normocytic normochromic anemia, but no evidence of a marked hyponatremia. Brain magnetic resonance imaging with diffusion-weighted sequences showed hyper-intense signal abnormalities in the extrapontine region, sparing the basis pontis. Here, we report on the case of a patient with reversible cerebellar ataxia related to extrapontine myelinolysis without hyponatremia after treatment with cisplatin-based chemotherapy for cholangiocarcinoma and discuss the literature on cerebellar ataxia in patients who underwent recent chemotherapy for malignancy.

Keyword

Cisplatin; Myelinolysis; Central pontine; Hyponatremia; Cerebellar ataxia

MeSH Terms

Anemia
Ataxia
Brain
Cerebellar Ataxia*
Cholangiocarcinoma*
Cisplatin
Drug Therapy*
Dysarthria
Female
Hematologic Tests
Humans
Hyponatremia*
Infusions, Intravenous
Magnetic Resonance Imaging
Middle Aged
Myelinolysis, Central Pontine*
Neutropenia
Cisplatin

Figure

• 

  Fig. 1. Magnetic resonance imaging of the brain showing a hyperintense lesion of demyelination in the extrapontine areas, including the corpus callosum, midbrain, internal capsule, and middle cerebellar peduncle. No abnormal findings are seen at the basis pontis in magnetic resonance imaging sequences. (A-C) T2-weighted images at axial plane. (D-F) Diffusionweighted images.

• 

  Fig. 2. A brain magnetic resonance imaging showing decreased signal intensity in bilateral cerebellar peduncles, with decreased hyperintensity in the corpus callosum, midbrain, and internal capsule noted on diffusion-weighted images after termination of the administration of cisplatin.

Reference

References

1. Adams RD, Victor M, Mancall EL. Central pontine myelinolysis: a hitherto undescribed disease occurring in alcoholic and malnourished patients. AMA Arch Neurol Psychiatry. 1959; 81:154–72.

2. Martin RJ. Central pontine and extrapontine myelinolysis: the osmotic demyelination syndromes. J Neurol Neurosurg Psychiatry. 2004; 75 Suppl 3:iii22–8.

3. King JD, Rosner MH. Osmotic demyelination syndrome. Am J Med Sci. 2010; 339:561–7.

4. Dolciotti C, Nuti A, Cipriani G, Borelli P, Baldacci F, Logi C, et al. Cerebellar ataxia with complete clinical recovery and resolution of MRI lesions related to central pontine myelinolysis: case report and literature review. Case Rep Neurol. 2010; 2:157–62.

5. Ho VB, Fitz CR, Yoder CC, Geyer CA. Resolving MR features in osmotic myelinolysis (central pontine and extrapontine myelinolysis). AJNR Am J Neuroradiol. 1993; 14:163–7.

6. Forster A, Nolte I, Wenz H, Al-Zghloul M, Kerl HU, Brockmann C, et al. Value of diffusion-weighted imaging in central pontine and extrapontine myelinolysis. Neuroradiology. 2013; 55:49–56.

7. Steller U, Koschorek F, Strenge H. Cerebellar ataxia with recovery related to central pontine myelinolysis. J Neurol. 1988; 235:379–81.

8. Weissman JD, Weissman BM. Pontine myelinolysis and delayed encephalopathy following the rapid correction of acute hyponatremia. Arch Neurol. 1989; 46:926–7.

9. Garzon T, Mellibovsky L, Roquer J, Perich X, Diez-Perez A. Ataxic form of central pontine myelinolysis. Lancet Neurol. 2002; 1:517–8.

10. Kim J, Song T, Park S, Choi IS. Cerebellar peduncular myelinolysis in a patient receiving hemodialysis. J Neurol Sci. 2007; 253:66–8.

11. Yau TK, Yiu HY, Lee WM. Central pontine myelinolysis: report of two occurrences after cisplatin-containing chemotherapy for nasopharyngeal carcinoma. Clin Oncol (R Coll Radiol). 1993; 5:395–6.

12. Patel SV, Parish DC, Patel RM, Grimsley EW. Resolution of MRI findings in central pontine myelinosis associated with hypokalemia. Am J Med Sci. 2007; 334:490–2.

13. Bahr M, Sommer N, Petersen D, Wietholter H, Dichgans J. Central pontine myelinolysis associated with low potassium levels in alcoholism. J Neurol. 1990; 237:275–6.