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Oncological effects on the central nervous system
Published in Anju Sahdev, Sarah J. Vinnicombe, Husband & Reznek's Imaging in Oncology, 2020
The development of new biological and immunotherapies has led to recognition of a wider range of neurotoxicities involving the peripheral, autonomic, and central nervous systems, shown in Figure 37.3. A number of these have well-described neuroimaging features. A comprehensive review of all possible neurotoxicity related to newer treatments is beyond the scope of this chapter. Only those conditions with a distinctive imaging appearance contributing to the diagnosis will be described. Several of the biologic or immune agents, including antibody therapies, carry risks for serious associated neurological disease, such as progressive multifocal leukoencephalopathy (PML), while others predispose to the more benign posterior reversible leukoencephalopathy syndrome (PRES) (10). Stroke and vaso-occlusive effects are associated with a more diverse range of cancer drug treatments (10). The immunosuppressant effect of many cancer treatments increases the risk of CNS infection, as well as predisposing to systemic infection.
Antimicrobial Agents and Neurotoxicity
Published in Firza Alexander Gronthoud, Practical Clinical Microbiology and Infectious Diseases, 2020
One of the adverse events that antibiotics are linked to is neurotoxicity, with seizures being the most reported neurological adverse event. However, based on current evidence, it is unclear how strong this association is and avoiding use of a particular antibiotic because of a potential risk of neurotoxicity leads to use of more broad-spectrum antibiotics or antibiotics with inferior effectiveness. This ultimately increases risk of antimicrobial resistance and compromises patient safety and outcome. Neurotoxicity, on the other hand, can have severe complications, and some may go unrecognized for a prolonged time. It is therefore worthwhile to consider the following.
Nalidixic Acid and Other Quinolones
Published in M. Lindsay Grayson, Sara E. Cosgrove, Suzanne M. Crowe, M. Lindsay Grayson, William Hope, James S. McCarthy, John Mills, Johan W. Mouton, David L. Paterson, Kucers’ The Use of Antibiotics, 2017
Neurotoxicity is uncommon, but includes visual disturbances, a sense of excitement, depression, confusion, and hallucinations. Amfonelic acid, a derivative of nalidixic acid, was originally developed as a central nervous system stimulant (McMillen and Shore, 1978). Headache, giddiness, insomnia, drowsiness, syncope, and sensory changes have also been described (Cahal, 1965). Visual disturbances include excessive sensitivity to bright light, blurred vision, difficulty in focusing, decreased visual acuity, diplopia, and alteration in color perception. Convulsions have occurred in small numbers of patients (Islam and Sreedharan, 1965; Ronald et al., 1966; Fraser and Harrower, 1977; Paul, 1989). Acute reversible psychosis has been observed in a patient treated with large doses of nalidixic acid (Finegold et al., 1967). Similarly, Kremer et al. (1966) described an adult patient with acute glomerulonephritis who developed a paranoid state after treatment with nalidixic acid for a urinary infection.
Vincristine-induced neurotoxicity in pediatric patients with rhabdomyosarcoma: A retrospective analysis of clinical features and outcome
Published in Pediatric Hematology and Oncology, 2022
Lama Dakik, Maya Basbous, Hani Tamim, Yacoub Moubarak, Nidale Tarek, Dima Hamideh, Samar Muwakkit, Miguel Abboud, Raya Saab
In contrast to other reports, we were able through this single institution review, to investigate the duration of neuropathy, feasibility of dose re-escalation, and the potential association of the dose reductions with overall patient outcome. We found that 47% of patients had improvement of their symptoms while on-therapy, allowing re-escalation of subsequent dosing. Neurotoxicity persisted in 4 patients throughout their treatment despite early dose reduction, and symptoms persisted for months to years in some patients. A previous study in a different patient population also showed neuropathy to persist beyond 6 months after treatment especially in solid tumor patients,14 while other studies have shown nerve conduction velocity abnormalities to persist for 6 months to several years post treatment.1,15 Importantly, most of our patients who had long-term follow-up data captured (73%) had complete eventual resolution of motor neuropathy, as documented by physical examination. Within the limitation of the small sample size, disease and survival outcome analyses in our series showed no apparent impact of vincristine dose reduction on disease control.
Safety considerations of current drug treatment strategies for nosocomial pneumonia
Published in Expert Opinion on Drug Safety, 2021
Adrian Ceccato, Pierluigi Di Giannatale, Stefano Nogas, Antoni Torres
The main side effect of colistin is nephrotoxicity, with a prevalence of 20%–76% during treatment. Although the mechanism of nephrotoxicity is unknown, it is known to be dose-dependent, and reversibly [60,61]. High body mass index and higher dose adjusted for body weight have been associated with a higher incidence of nephrotoxicity [62–64]. Colistin is also associated with neurotoxicity, typically presenting with paresthesia, and has an incidence of approximately 7%. Neurotoxicity may also present with visual disturbances, vertigo, mental confusion, ataxia, and seizure. The most severe presentation is a myasthenia-like syndrome with respiratory muscles paralysis [65]. This may present similarly to critical illness polymyoneuropathy, so care must be taken to avoid misdiagnosis.
Isolated Abducens Nerve Palsy Following Pembrolizumab
Published in Neuro-Ophthalmology, 2020
Korey A. Jaben, Jasmine H. Francis, Alexander N. Shoushtari, David H. Abramson
As immune checkpoint blockade becomes more ubiquitous across oncology and as prolonged patient survival allows for extended medication use, the importance of prompt diagnosis and management of immune-related toxicities induced by immune checkpoint blockade will grow. Efficacy data to date suggest patients with melanoma requiring interruption of checkpoint inhibition due to irAEs do not have worse efficacy outcomes, underscoring the importance of cessation of PD-1 blockade when serious irAEs arise.16,17 While neurotoxicity is reported to be present in a small cohort of patients, this case serves as another example that the toxicities can be significant. There is presently a paucity of data from which practitioners can draw to guide management, and as the use of these drugs expand, it will be important to continue to contribute to the existing database of cases to concurrently expand our knowledge of data and outcomes.