Myelopathy after intrathecal chemotherapy. A case report with unique magnetic resonance imaging changes

Abstract

Background. Paraplegia caused by intrathecal chemotherapy has no known pathognomonic features and is a diagnosis of exclusion. Methods. The authors reported the clinical and neuroimaging findings in one patient with this syndrome. Results. The patient had severe paraplegia with urinary retention and impaired pain and touch sensation below T‐10 with sparing of proprioception and vibration sense. Magnetic resonance imaging (MRI) scan showed diminished intensity throughout the central cervical spinal cord. Post‐gadopentetate dimeglumine enhancement was scattered throughout the cervical spinal cord and in two areas of the dorsal spinal cord. Axial views of the cervical spinal cord showed that this enhancement was limited to the lateral columns. Conclusions. The MRI in myelopathy due to intrathecal chemotherapy may show a unique pattern of post‐gadopentetate dimeglumine enhancement limited to the lateral columns of the spinal cord. However, two recently encountered patients with the same syndrome did not show similar changes. Cancer 1994; 73:3037–40.

Lateral and Dorsal Column Hyperintensity on Magnetic Resonance Imaging in a Patient with Myelopathy Associated with Intrathecal Chemotherapy

“…MBP levels are frequently increased in the CSF, as previously reported [7]. MRI findings of intrathecal chemotherapy-related myelopathy include high signal intensity in T2-WI within the central and posterior columns [8], cord swelling, gadolinium enhancement restricted to the lateral columns [9], and the features of arachnoiditis [10]. …”

Anterior lumbosacral polyradiculopathy after intrathecal administration of methotrexate

“…Self-limited chemical arachnoiditis is the most common ITM neurotoxic effect (10%-50%) followed by myelopathy (b3%) [8,9]. Myelopathy usually begins early after injection and is characterized by incomplete transient paraparesis and ascending sensory loss [2]. The cause is often multifactorial, affecting patients who are receiving concurrent intrathecal drugs, repetitive injections of drugs, accidental overdose or concomitant radiotherapy.…”

“…Following the administration of intrathecal methotrexate (ITM), chemical arachnoiditis and transient inflammatory myelopathy are the most common adverse events [2]. Anterior lumbosacral polyradiculopathy is a rare complication usually reported in children, an inflammatory demyelinating process with habitually good response to immune treatments and complete or almost complete recovery in many cases [3,4].…”

Toxicity of treatment for neoplastic meningitis

“…The diagnosis may be suggested by MRI findings (Fig. 2), which may reveal cord swelling, hyperintensity of the affected spinal cord segments on T 2 -weighted images, or irregular gray matter enhancement by gadolinium [28][29][30]. Pathologically, portions of the spinal cord reveal demyelination with associated white-matter vacuolization [27,28].…”