[Clinical research on acute paraplegia resulting from intrathecal chemotherapy]

Objective: To investigate the potential pathogenesis of acute paraplegia resulting from intrathecal chemotherapy and to analyze the factors influencing prognosis. Methods: Six cases presented with acute paraplegia after intrathecal chemotherapy for leukemia from January 1(st,) 2015 to June 1(st,) 2017 in our hospital. The patients' clinical manifestation, data of imaging and cerebrospinal fluid were analyzed. Result: Six patients with leukemia were with an average age of 27.3 (7 to 55) years old. Four cases were intrathecally injected with cytarabine, and two cases were intrathecally injected with cytarabine and methotrexate. Paraplegia occurred in 5 patients during or immediately after the injection; pain occurred in 1 patient immediately after the injection followed with paraplegia 2 h later. Four patients underwent MRI scan of the spinal cord but failed to show responsible lesions. The youngest patient who received the most frequent intrathecal injections, the highest dosage of cytarabine, combination with methotrexate set up the most serious symptoms and the poorest prognosis. Conclusions: Cytarabine has close relationship with the occurrence of paraplegia. The possible risk factors of poor prognosis might be younger age, more frequent injections, higher dosage, combination of cytarabine and methotrexate.