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Amnesia, change in character and toxic encephalopathy: case report A 67-year-old woman developed amnesia, change in character and toxic encephalopathy during treatment with paclitaxel, trastuzumab and pertuzumab for breast carcinoma. The woman underwent resection of breast carcinoma on the right side following which a port catheter was implanted on the left side epipectoral for adjuvant chemotherapy with intra-arterial administration of paclitaxel, pertuzumab and trastuzumab [dosages not stated]. Following the implantation of port, she reported pain in the middle and index finger of her left hand. During administration of the first cycle of chemotherapy via the port in an oncology practice (day 20 following the port implantation), she exhibited an acute change in the character with confusion as well as right-sided neglect. She did not recognise her husband at first. The woman’s chemotherapy was paused following which the symptoms resolved completely after 15 min. After 2 hours, a second attempt of chemotherapy was made. There was a change of character again with psychomotor slowdown, confusion and weakness of the right side of her body. A suspicion of psycho-syndrome as the cause of the symptoms was made. Immediately following the second chemotherapy, a hypertensive crisis occurred [aetiology not stated]. Therefore, she was moved to the emergency room. Over the subsequent course of treatment, she exhibited a fluctuation of symptoms. In addition to her neurological symptoms, angina pectoris symptoms were observed. Investigations led to a diagnosis of acute bihemispheric cerebral infarcts and non-ST elevation myocardial infarction, which were evaluated as arterio-arterial embolisms secondary to the port misplacement. The pain in her finger was also attributed to the port misplacement. Therefore, the port catheter was removed surgically. In addition, her amnesia and pronounced fluctuations in the acute phase (change in character) were considered as additional toxic encephalopathic component under the intra-arterial chemotherapy administration [not all outcomes stated]. Griesinger L, et al. Finger pain and personality changes after chemotherapy initiation via a central venous port system in a 67-year-old female patient. Internist 61: 1055-1058, 803514893 No. 10, 2020. Available from: URL: http://doi.org/10.1007/s00108-020-00848-3 [German; summarised from a translation]

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Reactions 14 Nov 2020 No. 1830