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Ascending myeloencephalopathy due to intrathecal vincristine sulfate. A fatal chemotherapeutic error
Author(s) -
Williams Michael E.,
Walker An.,
Bracikowski James P.,
Garner Lowell,
Wilson Kevin D.,
Carpenter Johnson T.
Publication year - 1983
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/1097-0142(19830601)51:11<2041::aid-cncr2820511114>3.0.co;2-g
Subject(s) - vincristine , medicine , autopsy , cerebrospinal fluid , spinal cord , coma (optics) , chemotherapy , anesthesia , surgery , pathology , cyclophosphamide , physics , psychiatry , optics
A case of fatal myeloencephalopathy secondary to accidental intrathecal administration of vincristine is reported in a 16‐year‐old boy. He underwent a progressive ascending chemical meningoencephalitis leading to coma, and died 36 days after the injection. Multiple samples of cerebrospinal fluid (CSF) and serum were assayed for vincristine sulfate. CSF levels of vincristine were consistently much higher than serum levels. At autopsy, all regions of the brain that had been in direct contact with the CSF were necrotic. The spinal cord was likewise necrotic throughout its length. Microscopically there was total neuronal loss with tissue destruction in the affected regions. The presence of numerous gemistocytic astrocytes, some in arrested mitosis, was a conspicuous feature in these areas. Three previous reports of intrathecal vincristine instillation are reviewed. No treatment for this devastating iatrogenic error exists, underscoring the importance of preventive measures in chemotherapy administration.