Related Experiment Videos
Vincristine-induced recurrent laryngeal nerve paralysis in children
1St. Jude Children's Research Hospital, Department of Anesthesia, Memphis, Tennessee.
Insights
Vincristine therapy for cancer can cause stridor in children due to vocal cord paralysis. Reducing the vincristine dose or stopping treatment resolves this serious side effect.
Area of Science:
- Pediatric Oncology
- Neuro-oncology
- Clinical Toxicology
Background:
- Vincristine is a common chemotherapy agent used for various pediatric malignancies.
- Neurotoxicity is a known side effect of vincristine treatment.
- Stridor, a high-pitched breathing sound, can indicate upper airway obstruction.
Observation:
- Two pediatric patients receiving vincristine therapy for malignancies developed stridor.
- Indirect laryngoscopy identified left vocal cord paralysis in both affected children.
- One patient exhibited generalized vincristine neurotoxicity, while the other had isolated laryngeal nerve paralysis.
Findings:
- Vincristine-induced vocal cord paralysis can manifest as stridor in children.
- Stridor resolved in both patients upon discontinuation or dose reduction of vincristine.
- Laryngeal nerve paralysis is a potential, albeit less common, neurotoxic manifestation of vincristine.
Implications:
- Clinicians should consider vincristine-induced vocal cord paralysis in pediatric patients presenting with stridor.
- Prompt airway visualization is crucial for diagnosing stridor in immunocompromised children.
- Management involves adjusting vincristine dosage or cessation to mitigate neurotoxic effects and airway compromise.
Abstract:
Stridor developed in 2 children during vincristine therapy for malignancies. Indirect laryngoscopy revealed left vocal cord paralyses in both patients. One child had generalized neurotoxicity from vincristine including hypotonia, decreased gastrointestinal motility, and painful paresthesias while laryngeal nerve paralysis was the only neurotoxic manifestation in the other patient. Stridor resolved in both patients after discontinuing or decreasing the dose of vincristine. Visualization of the airway not only confirms the diagnosis, but also rules out treatable causes of stridor in the febrile, immunocompromised patient.