Objective:

Background:

CVDs, such as ischemic stroke, have been shown to be a common comorbidity in cancer patients, often worsening their prognosis and condition. Blinatumomab is a bispecific T-cell engager used in acute lymphoblastic leukemia (ALL) and is associated with complex neurologic immune-related adverse events (ir-AEs). Ir-AEs include headache, seizures, aphasia, and encephalopathy and are typically managed with infusion interruptions or dexamethasone therapy.

Design/Methods:

Case report

Results:

A 39-year-old lady undergoing in-hospital chemotherapy for ALL developed acute onset of global aphasia and right facial droop on day 28 of treatment with blinatumomab prompting activation of a stroke alert. Her initial NIHSS was 11, neuroimaging (CT brain w/o contrast and CTA brain and neck) were negative. Neurology evaluated the patient within 15 minutes from her last known well. While blinatumomab-induced neurotoxicity was amongst the differentials, due to the focal neurological findings, risk for permanent disability and concern for an acute ischemic stroke, the patient received intravenous therapy with alteplase. Post-thrombolytic therapy, the patient’s neurological examination improved and her NIHSS decreased from a 11 to 0. MRI brain the next day confirmed an aborted stroke with a small area of restricted diffusion in the left frontal operculum. At her nine-month outpatient clinic follow-up, the patient continues to do well neurologically and is on apixaban for secondary stroke prevention.

Conclusions:

An acute neurological change in a patient requires rapid triage and time-sensitive decision making. In patients with cancer who are on immunotherapy with agents such as Blinatumomab, the differentiation of etiologies such as stroke and stroke mimics can be challenging as many of the symptoms of neurologic ir-AEs of Blinatumomab can mimic CVD.