A reversible brain syndrome after chemotherapy for stage IIB lung cancer

What happened, in summary

A 65-year-old woman with stage IIB squamous cell carcinoma of the lung was brought to the emergency department after her first tonic-clonic seizure. Two months earlier, she had undergone right upper lobectomy with mediastinal lymph-node dissection. She had recently started adjuvant cisplatin and vinorelbine.

Her first combined chemotherapy cycle began one week before the neurological event. Twelve hours before admission, she had received a second treatment containing vinorelbine alone. After the seizure, she had transient neurological changes. Initial CT did not show a clear brain abnormality, but MRI demonstrated the characteristic symmetric posterior changes of posterior reversible encephalopathy syndrome, or PRES. The imaging supported vasogenic brain edema rather than a stroke or brain metastasis.

The treating team considered chemotherapy the most plausible trigger. Vinorelbine had the closest timing, although a contribution from cisplatin could not be excluded. Both drugs were discontinued. She also had severe leukopenia and neutropenia, reinforcing concern about treatment toxicity.

Her neurological symptoms and signs resolved during hospitalization. She was discharged on levetiracetam 500 mg every 12 hours and had no residual neurological deficit at that time. Her experience highlights the need to investigate new seizures promptly during chemotherapy. Early MRI identified a reversible treatment complication that was not visible on the initial CT and allowed the suspected drugs to be stopped before further exposure.