Unusual cervical spinal cord toxicity associated with intra-arterial carboplatin, intra-arterial or intravenous etoposide phosphate, and intravenous cyclophosphamide in conjunction with osmotic blood brain-barrier disruptionin the vertebral artery

BACKGROUND AND PURPOSE: When the clinical and radiologic characteristics of an unusual cervical spinal cord complication of intra-arterial (IA) chemot herapy with blood brain-barrier (BBB) disruption in the vertebral circulati on are documented. Seven cases are reported and analyzed in search of a pat hophysiologic explanation. METHODS: We retrospectively identified 94 patients who received a total of 380 standardized regimens of IA carboplatin, IA or IV etoposide phosphate, and PV cyclophosphamide infusion in conjunction with osmotic BBB disruption of the vertebral artery. We describe seven of those patients in whom unexp ected neck pain developed followed by neurologic symptoms primarily in the upper extremities. RESULTS: The symptoms correlated with MR abnormalities (T1 hypointensity, T 2 hyperintensity, and unusual contrast enhancement) in the cervical spinal cord, usually involving the gray matter. The neurologic deficits and MR cha nges were generally transient. One patient who received a flu vaccination 4 8 hours before the chemotherapy incurred progressive myelitis and expired. CONCLUSION, The pathophysiology of this complication is probably multifacto rial but may be related to vascular streaming and an atypical inflammatory toxic reaction to carboplatin and etoposide, The complication has not recur red during a 6-month period following modification of the protocol.