Cerebellar toxicity of cytosine arabinoside: Clinical and neuropsychological signs

Abstract

High -dose cytosine arabinoside (ARA-C) therapy administered for acute nonlymphocytic leukemia causes cerebellar toxicity.1 Complications are usually transient and mild but may be severe and permanent in rare cases. Autopsies have revealed that Purkinje cells are most vulnerable, but minor, patchy cell loss in molecular and granular layers of the cerebellum may also occur.1 Deep cerebellar nuclei are minimally affected. Aside from cerebellar signs such as ataxia, dysarthria, and oculomotor impairment, confusion and drowsiness have also been described.1 Neuropsychological performance has not been described in these patients. Our patient, who has an old and static lesion and known cerebellar pathology, may provide further insights into the controversial theories of the cerebellum’s role in cognition. A 38-year-old, left-hand–dominant woman was diagnosed with acute myelogenous leukemia in 1990. She was treated with chemotherapy, Adriamycin 76 mg and ARA-C 340 mg per day for 5 days via continuous infusion (CALGB protocol #9022). On day 34, she was given her first intensification of chemotherapy, which consisted of ARA-C 5.1 …