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Vincristine-induced cranial neuropathy
Ahmad Talebian1, Razieh Moazam Goudarzi2, Mahdi Mohammadzadeh1
1Trauma Research Center, Kashan University of Medical Sciences, Kashan, Iran ; Department of Pediatrics, Kashan University of Medical Sciences, Kashan, Iran.
Iranian Journal of Child Neurology
|March 26, 2014
Summary
Vincristine, a chemotherapy drug, rarely causes cranial nerve damage. A child with Wilms' tumor developed ptosis, a rare side effect, which resolved with pyridoxine and pyridostigmine treatment.
Area of Science:
- Pediatric Oncology
- Neuro-oncology
- Clinical Pharmacology
Background:
- Vincristine (VCR) is a widely used vinca alkaloid in treating various malignancies.
- While VCR commonly causes peripheral neuropathy, cranial neuropathies are infrequent side effects.
Observation:
- A 2.5-year-old boy with Wilms' tumor developed bilateral ptosis three weeks after initiating VCR and dactinomycin treatment.
- The patient received a cumulative VCR dose of 3.015 mg prior to the onset of ptosis.
- Neurological examination confirmed bilateral ptosis with preserved pupillary reflexes and eye movements.
Findings:
- Prompt administration of pyridoxine and pyridostigmine as neuroprotective agents led to complete resolution of ptosis within seven days.
- The patient completed the planned six-week treatment course without recurrence of ptosis.
Implications:
- This case highlights the potential for vincristine-induced cranial neuropathy, specifically ptosis, in pediatric oncology.
- Early recognition and intervention with pyridoxine and pyridostigmine can effectively manage this rare neurotoxic side effect.
- Further research into neuroprotective strategies during vinca alkaloid chemotherapy is warranted.
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