5-fluorouracil-induced leukoencephalopathy with acute stroke-like presentation fulfilling criteria for recombinant tissue plasminogen activator therapy.

A 61-year-old man underwent systemic chemotherapy with intravenous infusion of nedaplatin and 5-fluorouracil. On the day after the final drug administration, he suddenly experienced difficulty in speaking followed by left-sided weakness. His National Institutes of Health Stroke Scale score was 12. A computed tomographic scan of the brain performed 4 hours after symptom onset revealed no abnormalities. Because all eligibility criteria were fulfilled, he immediately underwent intravenous recombinant tissue plasminogen activator therapy. He recovered from neurologic complications on day 14. An initial magnetic resonance imaging scan of his brain revealed a hyperintense area in the bilateral white matter and corpus callosum, and these abnormalities had improved on the follow-up scan. We diagnosed him with 5-fluorouracil-induced leukoencephalopathy with acute stroke-like presentation. Our experience suggests that 5-fluorouracil-induced leukoencephalopathy potentially fulfills all eligibility criteria for recombinant tissue plasminogen activator therapy.