Described here is a case of accidental intrathecal administration of vincri
stine with pathologic findings in the central nervous system. A 3-year-old
boy with acute lymphoblastic leukemia, was given his ninth course chemother
apy. Vincristine was accidentally injected intrathecally. The clinical cour
se was rapidly progressive (6-day course) and resulted in death. An autopsy
was done. The brain and spinal cord was grossly edematous and congested wi
thout any specific feature. Histologically, profound loss of neuron was not
ed in the spinal cord. Remaining neurons in the spinal cord, particularly a
nterior horn cells were markedly swollen. The spinal nerves show diffuse ax
onal degeneration and myelin loss. The upstream portion of the spinal cord
(brain stem, cerebellum. cerebrum) showed patchy loss of neurons, especiall
y Purkinje cells and granular cells of the cerebellar cortex. Many neurons
showed axonal reaction (chromatolysis) with swelling. Several neurons show
intracytoplasmic eosinophilic inclusion body. Myelin loss, axonal swelling
and enlargement of perivascular spaces were seen throughout the white matte
r of central nervous system.