Cisplatin
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Polyneuropathy and autonomic dysreflexia : case report An approximately 49-year-old man developed polyneuropathy followed by autonomic dysreflexia, after receiving cisplatin for epipharynx carcinoma. At the age of 51 years, the man was admitted with progressive gait disturbance, weakness of the left upper limb and dysuria. Two years previously, he received radiation therapy and cisplatin chemotherapy (total 220mg) [route not stated] for epipharynx carcinoma. Five months later, he developed difficulty walking, followed by odynophagia, requiring tracheostomy following diagnosis of radiation chondritis. One year prior, weakness and numbness of the left limbs occurred, which extended to the opposite side and was followed by micturition difficulties. Following a desire to void, he experienced face, neck and shoulder perspirations. He had a tracheal cannula, and required intermittent self-catheterisation. The cranial nerves were intact. He had tetraparesis with spasticity, more prominent on the left than the right side. On bedside inspection (following latest presentation), fasciculations were noted in muscles, innervated by C5–C7 cervical segments. Deep tendon reflexes were absent in the lower extremities. Babinski’s sign was positive on the left. He had hypoesthesia below C4 dermatome on both the sides. Deep-sensation was diminished on both the lower limbs. CSF cell count was 2 cells/mm3 and protein content was 26 mg/dL. An MRI of the cervical cord showed that C5–C7 segments were swollen, and showed high signal intensity on T2-weighted images. On T1-weighted images, the lesion was slightly hypointense, and was enhanced by Gadolinium-EDTA. The Axial sections demonstrated bilaterally enhanced lesions, mainly involving the lateral portion. Sweat tests were performed. Thermal sweating (TS) was induced by heating the man in the supine position with electric blankets. In order to evaluate the postganglionic sympathetic function, acetylcholine-induced sweating (Ach-S) was achieved by injecting acetylcholine [acetylcholine chloride] on the forearm and the leg on the left side. TS was largely defective. Fifty minutes following heating initiation, discolouration was noted on the right side of the forehead, neck and around the right shoulder involving T1 sensory dermatome. The right shoulder and the upper limb demonstrated patchy sweat spots. The face showed only slight discoloration on the left side. The rest of the body was anhidrotic. Sweating due to autonomic dysreflexia (AD) was induced naturally. Following withdrawal of self-catheterisation for several hours, he lied on the bed with his face and upper parts of the body wrapped with test sheets. When he had the desire to void, no sweating was noted. Following this, he was requested to stand up and walk around. Within a few minutes, his desire to void became intense, and sweating appeared rapidly on the face and neck, followed by the upper chest. Following self-catheterisation, sweating subsided. No sweating was noted during and after insertion of the indwelling tube. Af
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