Bilateral blindness and lumbosacral myelopathy associated with high-dose carmustine and cisplatin therapy

PURPOSE: To report the early ocular pathologic findings associated with hig h dose carmustine and cisplatin therapy. METHODS: A patient with metastatic breast carcinoma developed an acute onse t of branch retinal artery occlusion, bilateral blindness, and a myelopathy involving the lower extremities after high dose chemotherapy and bone marr ow transplant. RESULTS: Histopathologic examination of the eye and optic nerves at autopsy disclosed nerve fiber layer infarction secondary to right inferior tempora l retinal artery thrombosis. Patchy necrosis of both optic nerves, medulla oblongata, and spinal cord was associated with focal small-vessel thrombosi s, CONCLUSIONS: The syndrome of retinal vascular occlusion, optic neuropathy, and myelopathy is associated with the high-dose chemotherapeutic agents car mustine and cisplatin, The distribution of necrosis suggests an ischemic ev ent rather than direct neurotoxic effects, (C) 2000 by Elsevier Science Inc . All rights reserved.