A Rare Case of Docetaxel-Induced Hydrocephalus Presenting with Gait Disturbances Mimicking and Coexisting with Taxane-Associated Polyneuropathy: The Relevance of Differential Diagnosis, Clinical Assessment, and Response to Ventriculoperitoneal Shunt

Abstract

Docetaxel constitutes a widely used chemotherapeutic agent as a first-line treatment for several neoplastic diseases. One of the most common side effects induced by this drug is polyneuropathy, which among other symptoms can cause gait disbalance. However, in exceptional cases gait disturbances could be related to docetaxel-induced hydrocephalus, a rare event that up to the present has been overseen throughout the medical literature and should be meticulously differentiated from polyneuropathy, since its clinical features, treatment, and prognosis differ drastically. We present the case of a woman with a progressive gait disturbance that started immediately after having been treated with docetaxel for breast cancer resembling the same clinical characteristics as seen in patients affected by normal pressure hydrocephalus. The symptoms had been observed for about 2 years as having been caused only by polyneuropathy, given the high incidence of this side effect and the accompanying numbness of distal extremities. However, brain MRI evidenced a marked enlargement of the ventricular system. Brain metastases as well as carcinomatous meningitis were ruled out. After having placed a ventriculoperitoneal shunt, the patient showed a rapid, long-lasting and outstanding improvement of gait performance. We discuss the coexistence, in this case, of taxane-associated hydrocephalus and polyneuropathy and describe the clinical features, assessment and surgical outcome of docetaxel-induced hydrocephalus, since its early recognition and differentiation from the highly frequent taxane-associated polyneuropathy has relevant consequences for the management and treatment of these patients.