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Paraplegia following intrathecal chemotherapy: neuropathologic findings and elevation of myelin basic protein
Abstract:
An 11-year-old boy developed a severe myelopathy after an eight-year history of acute lymphoblastic leukemia and numerous courses of intrathecal chemotherapy. Myelin basic protein in the cerebrospinal fluid (CSF) was elevated. Neuropathologic examination disclosed extensive microvacuolar changes in the white matter of the spinal cord. The pathogenesis of myelopathy following intrathecal chemotherapy administered by lumbar puncture includes an early effect on the myelin sheath. Serial assessment of CSF myelin basic protein levels in patients receiving intrathecal chemotherapy may be useful in the early diagnosis of this disorder.
Insights
Intrathecal chemotherapy can cause severe myelopathy in children with acute lymphoblastic leukemia. Monitoring myelin basic protein in cerebrospinal fluid may aid early diagnosis of this neurological complication.
Area of Science:
- Neurology
- Oncology
- Chemotherapy
Background:
- Acute lymphoblastic leukemia (ALL) treatment often involves intrathecal chemotherapy.
- This case highlights a severe neurological complication in a pediatric patient.
Observation:
- An 11-year-old boy with a history of ALL developed severe myelopathy.
- Elevated myelin basic protein levels were detected in the cerebrospinal fluid (CSF).
- Neuropathology revealed microvacuolar changes in the spinal cord white matter.
Findings:
- Intrathecal chemotherapy can induce myelopathy, potentially through early effects on the myelin sheath.
- Myelin basic protein elevation in CSF correlates with chemotherapy-induced myelopathy.
Implications:
- Serial CSF myelin basic protein assessment may facilitate early diagnosis of myelopathy in patients undergoing intrathecal chemotherapy.
- Understanding the pathogenesis of chemotherapy-induced neurological toxicity is crucial for patient management.