ENCEPHALOPATHY, MYELOPATHY, OPTIC NEUROPATHY, AND ANOSMIA ASSOCIATED WITH INTRAVENOUS CYTOSINE-ARABINOSIDE

Coma, hemiparesis, unilateral optic neuropathy, and anosmia manifested in a patient with leukemia after he received only three courses of in travenous high-dose cytosine arabinoside (ARA-C). The patient's mental status returned to normal after several days, and his hemiparesis res olved. However, the visual loss persisted, and near complete visual lo ss in the other eye ensued over the following month. Severe bilateral optic atrophy appeared as the visual loss progressed. Anosmia became e vident after resolution of the coma and did not improve. The patient h ad previously had a thoracic myelopathy 2 weeks after receiving low-do se i.v. ARA-C. The neurotoxicity of high-dose i.v. ARA-C may arise at much lower cumulative doses than has been reported. In addition to cer ebellar dysfunction and somnolence, high-dose i.v. ARA-C may produce o ptic neuropathy, anosmia, and hemiparesis.