Capecitabine-induced oromandibular dystonia: A case report and literature review

Figures & data

Figure 1a & b. 

Figure 2a & b.  Axial diffusion- (Figure 1a & b) and T2- (Figure 2a & b) weighted images showing restricted diffusion and T2 signal hyperintensity involving the corona radiata (arrows) and splenium of the corpus callosum (arrowheads) in a symmetrical manner at initial presentation.

Figure 3a & b.  Follow-up MR study performed a month later shows resolution of the previously noted T2W signal hyperintensity in the corona radiata with some residual T2W signal hyperintensity seen in the splenium of the corpus callosum (arrowheads).

Table I.  Summary of case reports on capecitabine-induced multifocal leukoencephalopathy.

Case report	Year of report	No of patients	Clinical manifestations	Median onset of neurological symptoms (day)	MRI findings	Outcome
Couch LS et al.^3	2003	1	Painful trismus and left sided neglect	Day 2	Diffuse white matter hyperintensity	Complete resolution of symptoms
Niemann et al.^4	2005	1	Painful spasms of throat and manidibular muscles (‘epilepsy-like symptoms’)	Day 6	Diffuse subcortical white matter alterations	Complete clinical and pathological recovery
Formica et al.^5	2005	1	Ataxia and jerking movements of extremities; progressed to coma	Day 7	Non-specific minimal low attenuation white matter	Complete recovery
Videnovic et al.^6	2005	5	Ataxia, headaches, short-term memory loss, confusion, vertigo, dysarthria and epilespy-like symptoms	Days 3–7	Increased signal on DWI, fluid attentuated, T2 sequences in areas of corpus callosum, brachium pontis and deep perventricular matter	All complete recovery/ minimal residual deficits