Cerebrospinal fluid lavage in the treatment of inadvertent intrathecal vincristine injection

Abstract

Vincristine, a widely used antineoplastic agent, is extremely toxic to the central nervous system. If given intrathecally, it produces a rapidly ascending, usually fatal, neuromyeloencephalopathy. We report a case of this complication in a 7-year-old girl with acute lymphoblastic leukemia who was receiving maintenance chemotherapy. During one treatment 0.5 mg of vincristine was erroneously injected into the lumbar subarachnoid space. Cerebrospinal fluid lavage was established within 2 h and continued for 24 h. After 7 days she developed a progressive sensorimotor paraplegia, which eventually stabilized as a paraparesis. Neurophysiological studies were consistent with an axonal type sensorimotor neuropathy. Magnetic resonance imaging of the spine was normal. Vincristine binds to cells, blocking mitosis, thus causing cell death. The associated central nervous system lesions are those of an ascending chemical leptomeningitis and ventriculitis. Cerebrospinal fluid lavage dilutes and removes the drug, thus limiting neural damage. At present this is the only treatment for intrathecal vincristine injection, and its early use in such an event is considered mandatory.

Local Intracerebral Administration of Paclitaxel with the Paclimer® Delivery System: Toxicity Study in a Canine Model

“…Clinical studies using CEDD of paclitaxel showed a similar complication, which was attributed to leakage of paclitaxel into the subarachnoid space (29). Accidental intrathecal administration of other anti-microtubule agents has been shown to produce a wide range of complications and should be avoided (31,32).…”

Accidental spinal potassium chloride injection successfully treated with spinal lavage

“…In theory, cerebrospinal fluid lavage dilutes and removes the drug, thus limiting neural damage. This is well demonstrated with antineoplasic drugs and with ionic contrast medium . For example, with accidental intrathecal vincristine administration, cerebrospinal fluid drainage and early irrigation has been related to a good outcome (prolonged survival with no encephalopathy) .…”

Fatal Accidental Intrathecal Injection of Vindesine

“…The intravenous administration of vindesine may lead to side effects, such as peripheral neurologic effects, for example paresthesias, a loss of deep tendon reflexes, or paralytic ileus (1)(2)(3)(4)(5)(6)(7)(8). However, vindesine is considered to be less toxic than the other chemotherapeutic agents, especially vincristine.…”