Irreversible paraplegia following one time prophylactic intrathecal chemotherapy in an adult patient with acute lymphoblastic leukemia.
We present an adult female patient who developed irreversible paraplegia and areflexia four days post intrathecal chemotherapy with methotrexate, cytosine arabinoside and hydrocortisone. On magnetic resonance imaging (MRI) of the lumbar spine, diffuse gadolinium enhancement of the anterior spinal nerve roots (ventral roots) was detected. Methylprednisolone was intravenously administered at a daily dose of 30mg/kg for three days. Despite this treatment, flaccid weakness in the lower extremities and urinary retention persisted. Following consolidation chemotherapy, no improvement in neurologic status was noted. Six months later, a follow-up MRI revealed severe atrophy of the thoracic spinal cord.
Lee
Hea Yong
HY
Division of Hematology and Oncology, Department of Internal Medicine, College of Medicine, Gyeong-Sang National University, Jinju 660-702, Korea.
Im
Sung-il
SI
Kang
Myoung-Hee
MH
Kim
Kwang Min
KM
Kim
Seok Hyun
SH
Kim
Hun-Gu
HG
Kang
Jung Hun
JH
Lee
Gyeong-Won
GW
D000328:Adult; D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D010264:Paraplegia / Q000139:chemically induced* / Q000473:pathology*; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000188:drug therapy*
D000970:Antineoplastic Agents