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Intrathecal vincristine: fatal myeloencephalopathy despite cerebrospinal fluid perfusion
Andrés Alcaraz1, Corsino Rey, Andrés Concha
1Department of Pediatrics, Hospital Central de Asturias, Oviedo, Spain.
Background:
Vincristine, an antineoplastic agent, must never be injected intrathecally because of its devastating neurotoxic effects, which are usually fatal. We report a case of fatal myeloencephalopathy secondary to inadvertent intrathecal administration of vincristine.
Case Report:
Intrathecal vincristine was inadvertently injected into a twelve-year-old girl with acute lymphocytic leukemia. The error was immediately recognized and treated with cerebrospinalfluid drainage and cerebrospinal fluid exchange. Clinical evolution during the 83 days until death is described Multiple samples of cerebrospinal fluid were assayed for vincristine sulfate. Neuropathological post-mortem changes in the brain and spinal cord are reported
Conclusion:
We compare our case with other previously reported cases in which patient survival was achieved with the same treatment. We summarize preventive measures to avoid such unfortunate occurrences.
Insights
Fatal myeloencephalopathy occurred in a child due to inadvertent intrathecal vincristine administration. Despite prompt treatment, the patient succumbed to severe neurotoxicity, highlighting the critical need for strict administration protocols.
Area of Science:
- Neuro-oncology
- Pharmacology
- Neuropathology
Background:
- Vincristine is a crucial chemotherapy agent for acute lymphocytic leukemia.
- Intrathecal administration of vincristine is contraindicated due to severe neurotoxicity.
- Accidental intrathecal vincristine injection can be fatal.
Observation:
- A 12-year-old girl with acute lymphocytic leukemia received inadvertent intrathecal vincristine.
- Immediate treatment included cerebrospinal fluid drainage and exchange.
- Clinical course over 83 days until death was documented, with vincristine sulfate levels monitored in cerebrospinal fluid.
Findings:
- The patient developed fatal myeloencephalopathy following intrathecal vincristine.
- Post-mortem examination revealed significant neuropathological changes in the brain and spinal cord.
- Comparison with cases achieving survival after similar treatment was performed.
Implications:
- This case underscores the catastrophic consequences of intrathecal vincristine administration errors.
- Strict adherence to administration protocols is essential to prevent fatal neurotoxicity.
- Preventive strategies are crucial to avoid such adverse events in clinical practice.