Reversible acute cerebellar toxicity (REACT) syndrome is a potentially reversible acute encephalopathic syndrome 1,2.
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Epidemiology
REACT is a rare syndrome that has been associated with several opioid and chemotherapeutic agents, including Minnelide 1,2.
Clinical presentation
Patients typically present with cerebellar symptoms, including gait ataxia, dysmetria, and balance and speech impairment, which may be accompanied by confusion 1.
Radiographic features
MRI
REACT syndrome presents on MRI with diffuse and symmetric FLAIR hyperintense changes with restricted diffusion of the cerebellar cortex 1. It typically lacks involvement of the cerebellar nuclei and supratentorial structures 1.
Treatment and prognosis
The syndrome may be reversible with discontinuation of the causative drug.
Differential diagnosis
- cerebellar infarction: irreversible and occurring in typical arterial territories
- acute cerebellitis: usually seen in children following viral illness
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