Journal of Neuro-Ophthalmology

Skip Navigation LinksHome > March 2010 - Volume 30 - Issue 1 > Clinical and Imaging Features of Fludarabine Neurotoxicity
Journal of Neuro-Ophthalmology:
doi: 10.1097/WNO.0b013e3181ce8087
Original Contributions

Clinical and Imaging Features of Fludarabine Neurotoxicity

Lee, Michael S MD; McKinney, Alexander M MD; Brace, Jeffrey R MD; SantaCruz, Karen MD

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Abstract

Neurotoxicity from intravenous fludarabine is a rare but recognized clinical entity. Its brain imaging features have not been extensively described. Three patients received 38.5 mg or 40 mg/m2 per day fludarabine in a 5-day intravenous infusion before bone marrow transplantation in treatment of hematopoietic malignancies. Several weeks later, each patient developed progressive neurologic decline, including retrogeniculate blindness, leading to coma and death. Brain MRI showed progressively enlarging but mild T2/FLAIR hyperintensities in the periventricular white matter. The lesions demonstrated restricted diffusion but did not enhance. Because the neurotoxicity of fludarabine appears long after exposure, neurologic decline in this setting is likely to be attributed to opportunistic disease. However, the imaging features are distinctive in their latency and in being mild relative to the profound clinical features. The safe dose of fludarabine in this context remains controversial.

© 2010 Lippincott Williams & Wilkins, Inc.

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