Subarachnoid hemorrhage during chemotherapy with ramucirumab: A case report

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  • Ohmura Kazufumi
    Department of Neurosurgery, Toyohashi Medical Center Department of Neurosurgery, Gifu Prefectural Gero Hospital
  • Takenaka Shunsuke
    Department of Neurosurgery, Toyohashi Medical Center
  • Sakai Hideki
    Department of Neurosurgery, Toyohashi Medical Center

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  • ラムシルマブによる化学療法中に発症したくも膜下出血の1例

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<p>We report a case of subarachnoid hemorrhage during chemotherapy with ramucirumab. A 64-year-old man who had a history of colon cancer treated with ramucirumab, an inhibitor of vascular endothelial growth factor receptor 2 (VEGFR2), was admitted to our hospital because of vomiting and disturbed consciousness. CT images showed a subarachnoid hemorrhage (SAH) in the left Sylvian fissure, and CT angiography showed a left middle cerebral artery (MCA) aneurysm. The diagnosis was an SAH due to a ruptured left MCA aneurysm. Because the side effects of ramucirumab include delayed skin healing and an increased risk of bleeding, the patient underwent coil embolization of the ruptured aneurysm rather than direct surgery. Postoperatively, he experienced a disturbance of consciousness, right hemiparesis and aphasia. MRI performed on postoperative 6 days showed multiple cerebral infarctions. Gradually his symptoms improved. He was discharged 53 days later after onset with a good clinical outcome (modified Rankin Scale, 0). We must carefully consider the best way to treat SAH during chemotherapy with an inhibitor of VEGFR and prepare for adverse events.</p>

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