Nilotinib
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Cerebrovascular stenosis and cerebral infarction: case report A 55-year-old man developed cerebrovascular stenosis and cerebral infarction during treatment with nilotinib for chronic myeloid leukaemia (CML). The man, who had CML, had been receiving nilotinib 300mg two times a day [route not stated] for 3 years. Later, he presented with a 2-day history of transient weakness of left-sided extremities. His symptoms worsened, which led to hospitalisation in January 2017. His neurological examination showed mild left-sided hemiparesis, dysphagia and dysarthria. MRI showed acute cerebral infarction at the right middle cerebral artery (MCA). Magnetic resonance angiography showed severe stenosis in the left MCA (M1) and right internal carotid artery (ICA). No moyamoya vessels were observed. A vessel-wall MRI showed diffuse concentric vessel wall thickening of the left MCA, right intracranial MCA and ICA. Based on the findings, ordinary atherosclerosis was ruled out. His blood test revealed a mild increase in LDL cholesterol level, while the serological examination was unremarkable for collagen, infectious and hormonal diseases. He had no history of arrhythmia, diabetes mellitus or hypertension. He was an occasional alcohol user and had an intermittent smoking habit. No family history of vascular diseases or stroke was reported. Hence, a diagnosis of cerebral infarction caused by nilotinib was considered. Nilotinib was stopped, and the man started receiving treatment with an unspecified high-potency statin and antiplatelet therapy. Three months after rehabilitation, his symptoms slowly improved. Hence, further examination of brain ischaemia was performed, and cerebral angiography showed previously identified intracranial lesions. A single photon-emission CT imaging showed poor perfusion of the right MCA around the ischaemic core. Therefore, 5 months after the initial presentation, he underwent direct revascularisation. Afterwards, he had no recurrence of brain ischaemia. Sixteen months after initial admission, MRI revealed no noticeable changes in his cerebral arteries. He was able to restart his daily activities. His treatment with nilotinib was changed to imatinib, which resulted in significant molecular remission. Suzuki K, et al. Vessel wall magnetic resonance imaging findings and surgical treatment in nilotinib-associated cerebrovascular disease: A case report. Molecular and Clinical 803499286 Oncology 10: 239-243, No. 2, Feb 2019. Available from: URL: http://doi.org/10.3892/mco.2018.1780
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