Cerebrospinal fluid lavage in the treatment of inadvertent intrathecal vincristine injection

Vincristine, a widely used antineoplastic agent, is extremely toxic to the central nervous system. If given intrathecally, it produces a rapidly ascen ding, usually fatal, neuromyeloencephalopathy. We report a case of this com plication in a 7-year-old girl with acute lymphoblastic leukemia who was re ceiving maintenance chemotherapy. During one treatment 0.5 mg of vincristin e was erroneously injected into the lumbar subarachnoid space. Cerebrospina l fluid lavage was established within 2 h and continued for 24 h. After 7 d ays she developed a progressive sensorimotor paraplegia, which eventually s tabilized as a paraparesis. Neurophysiological studies were consistent with an axonal type sensorimotor neuropathy Magnetic resonance imaging of the s pine 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 l avage 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.