Neural toxicity induced by accidental intrathecal vincristine administration

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.