PARAPLEGIA FOLLOWING INTRATHECAL CHEMOTHE RAPY

The occurrence of major neurologic disturbances is a rare complication of intrathecal cytotoxic drug administration. We describe the case of a 30-year-old man with relapsed lymphoblastic lymphoma and CNS involv ement who was treated by systemic chemotherapy (ESHAP) and intrathecal injections of methotrexate, cytarabine, thiotepa and hydrocortisone. Thereafter he developed persistent paraplegia with sensory and sphinct eric insufficiency. The role of the drug in causing this syndrome was suspected when more common causes, such as a meningeal carcinomatosis, had been excluded by means of CNF analysis and radiological examinati ons. We review this and other published cases and discuss the possible pathogenesis, as well as the clinical and paraclinical findings in pa raplegia following intrathecal chemotherapy. Patients particularly at risk are those who receive intrathecal chemotherapy for overt CNS dise ase rather than as prophylaxis, those who receive several injections a nd patients who are concomitantly treated with radiotherapy to the bra in or systemic high-dose methotrexate or cytarabine.