{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,17]],"date-time":"2026-06-17T16:01:45Z","timestamp":1781712105955,"version":"3.54.5"},"reference-count":11,"publisher":"BMJ","issue":"12","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2023,11,18]]},"published-print":{"date-parts":[[2023,12]]},"abstract":"<jats:p>A woman in her 60s was brought to the emergency department due to a new-onset seizure. She was drowsy on arrival and unable to provide a clinical history. She had a medical history of advanced endometrial cancer, for which she was under the therapeutic protocol pembrolizumab plus lenvatinib. Laboratorial investigations were unremarkable. The brain CT angiography provided further insight into the case by detecting a bilateral convexal subarachnoid haemorrhage with discrete bilateral opercular vasogenic oedema, without other noticeable structural changes. Cerebrospinal fluid analysis was macroscopically haemorrhagic, but otherwise unremarkable. The brain MRI did not provide additional information. Although considered a rare adverse reaction, cerebral haemorrhage has been described for both pembrolizumab and lenvatinib. We cautiously assumed a probable drug aetiology after a thorough review of potential causes. Following discontinuation of these drugs and under anti-convulsive therapy, the patient remained asymptomatic and was discharged home.<\/jats:p>","DOI":"10.1136\/bcr-2023-256100","type":"journal-article","created":{"date-parts":[[2023,12,11]],"date-time":"2023-12-11T21:00:38Z","timestamp":1702328438000},"page":"e256100","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":3,"title":["Convexal subarachnoid haemorrhage in a patient under pembrolizumab-lenvatinib combination therapy"],"prefix":"10.1136","volume":"16","author":[{"given":"Paulo","family":"Simao","sequence":"first","affiliation":[{"name":"Internal Medicine, Centro Hospitalar e Universitario de Coimbra EPE Campus dos Hospitais da Universidade de Coimbra, Coimbra, Portugal"},{"name":"Internal Medicine, Centro Hospitalar e Universit\u00e1rio Cova da Beira EPE, Covilh\u00e3, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-0417-5197","authenticated-orcid":false,"given":"Marco Jos\u00e9","family":"Almeida","sequence":"additional","affiliation":[{"name":"Neurology, Centro Hospitalar e Universitario de Coimbra EPE Campus dos Hospitais da Universidade de Coimbra, Coimbra, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0563-346X","authenticated-orcid":false,"given":"Jo\u00e3o","family":"Catela","sequence":"additional","affiliation":[{"name":"Neurosurgery, Centro Hospitalar e Universitario de Coimbra EPE, Coimbra, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fernando","family":"Matias","sequence":"additional","affiliation":[{"name":"Neurology, Centro Hospitalar e Universitario de Coimbra EPE Campus dos Hospitais da Universidade de Coimbra, Coimbra, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2023,12,11]]},"reference":[{"key":"2025082722374614000_16.12.e256100.1","doi-asserted-by":"publisher","DOI":"10.1177\/1073274818789361"},{"key":"2025082722374614000_16.12.e256100.2","doi-asserted-by":"crossref","first-page":"2777","DOI":"10.1080\/21645515.2016.1199310","article-title":"Pembrolizumab (Keytruda)","volume":"12","author":"Kwok","year":"2016","journal-title":"Hum Vaccin Immunother"},{"key":"2025082722374614000_16.12.e256100.3","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2108330"},{"key":"2025082722374614000_16.12.e256100.4","doi-asserted-by":"crossref","first-page":"1049","DOI":"10.1080\/14737140.2022.2128336","article-title":"Lenvatinib plus pembrolizumab combination therapy for adult patients with advanced renal cell carcinoma","volume":"22","author":"Ged","year":"2022","journal-title":"Expert Rev Anticancer Ther"},{"key":"2025082722374614000_16.12.e256100.5","doi-asserted-by":"crossref","DOI":"10.3389\/fphar.2022.774170","article-title":"Neurologic toxicity of immune checkpoint inhibitors: a review of literature","volume":"13","author":"Albarr\u00e1n","year":"2022","journal-title":"Front Pharmacol"},{"key":"2025082722374614000_16.12.e256100.6","doi-asserted-by":"crossref","first-page":"651","DOI":"10.1007\/s00280-016-3237-x","article-title":"Phase 1B study of pembrolizumab (MK-3475; 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