Encephalopathy in a patient with previous malignancy but normal brain imaging
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A 61-year-old man presented following two generalized tonic clonic seizures. For 2 weeks prior to admission he had had occipital headaches. The patient’s family had noticed a change in his personality with confusion, memory impairment, and unsteadiness when walking.
The patient had a history of non-small cell lung cancer (stage IV) diagnosed 2 years previously. He had completed three courses of chemotherapy with regimes of gemcitabine and carboplatin, docetaxel, and carboplatin with a clinical trial drug TZT1027. His most recent course was with oral gefitinib (Iressa). This was discontinued 6 months previously because of a persistent urticarial rash. He had no other significant past medical history.
On admission the patient was oriented in time and place. Hs speech was normal. He was afebrile. No focal neurologic deficits were noted. At the admitting hospital routine hematologic and biochemical investigations were normal. Liver transaminases were slightly elevated. A noncontrast enhanced CT scan of brain was reported as showing small vessel ischemic change. Lumbar …
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