case_images: PMC11032159_01
case_images: The treatment flow chart. VCR, vincristine, 1.5 mg/m2 (Dmax= 2.0 mg), d1, d8, d15; Act-D, actinomycin D, 0.045 mg/kg (Dmax=2.5 mg), d1; CTX, cyclophosphamide, 1.2 g/m2, d1; CPT-11, irinotecan, 50 mg/m2, d1-d5; ADR, Adriamycin, 30 mg/m2, d1-d2; VP-16, etoposide, 150 mg/m2, d1-d3; B, bevacizumab, 7.5 mg/kg, d1; CBP, carboplatin, 560 mg/m2, d1; IFO, ifosfamide, 1.8 g/m2, d1-d5; all chemotherapy regimens are repeated every 21 days. PR, partial remission; PD, disease progression.
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case_images: T2-weighted image on the lateral wall of the orbit, extensive meningeal metastasis, multiple intracranial metastases, and bilateral multiple cervical lymphadenopathy, suggesting tumor recurrence and progression (Figure S1). The brain metastases significantly reduced in size after the completion of four sessions of chemotherapy (Figure 1); however, the patient experienced weakness in both lower limbs and walking difficulty, the weakness spreads gradually from the distal end to the proximal end within 5 days.
case_images: EMG indicated reduced motor conduction velocity and prolonged latency of F-wave.
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case_images: The pathological reflex was negative. The cranial MRI, vertebral MRI, and cerebrospinal fluid analysis did not reveal any significant abnormality. The electromyogram (EMG) revealed a reduction in the motor conduction velocity, and the evoked potentials indicated prolonged latency of peripheral nerve action potentials, suggesting peripheral neuropathy (Figure 2).  
case_images: Sanger sequencing indicates the presence of both CYP3A4 rs2740574 TT (A) and CEP72 rs924607 CC genotypes (B).
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case_images: TT and CEP72 rs924607 CC genotypes (Figure 3). The patient's symptoms relieved gradually after oral administration of pyridoxine (vitamin B6), glutamine, and pyridostigmine.