Yonsei Med J.  2008 Feb;49(1):151-154.

Irreversible Paraplegia Following One Time Prophylactic Intrathecal Chemotherapy in an Adult Patient with Acute Lymphoblastic Leukemia

• Lee HY
• Im SI
• Kang MH
• Kim KM
• Kim SH
• Kim HG
• Kang JH
• Lee GW

Abstract

We present an adult female patient who developed irreversible paraplegia and areflexia four days post intrathecal chemotherapy with methotrexate, cytosine arabinoside and hydrocortisone. On magnetic resonance imaging (MRI) of the lumbar spine, diffuse gadolinium enhancement of the anterior spinal nerve roots (ventral roots) was detected. Methylprednisolone was intravenously administered at a daily dose of 30mg/kg for three days. Despite this treatment, flaccid weakness in the lower extremities and urinary retention persisted. Following consolidation chemotherapy, no improvement in neurologic status was noted. Six months later, a follow-up MRI revealed severe atrophy of the thoracic spinal cord.

Keyword

Acute lymphoblastic leukemia; cytosine arabinoside; intrathecal chemotherapy; methotrexate

MeSH Terms

Adult
Antineoplastic Agents/administration & dosage/*adverse effects/*therapeutic use
Female
Humans
Magnetic Resonance Imaging
Paraplegia/*chemically induced/*pathology
Precursor Cell Lymphoblastic Leukemia-Lymphoma/*drug therapy

Figure

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  Fig. 1 Sagittal MRI of the lumbar spine showing diffuse gadolinium enhancement of the anterior roots.

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  Fig. 2 Sagittal MRI showing heterogeneous high intensity lesions in the thoracic spinal cord.

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