Abstract
A patient with acute lymphoblastic leukaemia was mistakenly given vincristine intraventricularly, as part of an intensified course of chemotherapy. Despite a CNS washout and supportive treatment, the patient developed progressive ascending paralysis, gradually lapsed into coma and died some 10 days later. Autopsy and post-mortem histological examination showed evidence of brain death caused by florid encephalomyelitis, apparently induced by the intraventricular administration of vincristine.
Get full access to this article
View all access options for this article.
References
1.
Al Fawaz
I. M.
(1992 ) Fatal myeloencephalopathy due to intrathecal vincristine administration . Ann. Trop. Paediatr.
12 , 339 –42 .
2.
Barker
I.
(1993 ) Manslaughter conviction quashed . R. v. Dr M. C. Prentice and Dr B. Sullman. Australasian J. Med. Def. Union
3 , 46 –7 .
3.
BMJ
(1993 ) Manslaughter verdict quashed on junior doctors (News). BMJ
906 , 1432 –3 .
4.
Dyke
R. W.
(1989 ) Treatment of inadvertent intrathecal injection of vincristine (letter) . N. Eng. J. Med.
321 , 1270 –71 .
5.
Gaidys
W. G.
Dickerman
J. D.
Walters
C. L.
Young
P. C.
(1983 ) Intrathecal vincristine. Report of a fatal case despite CNS washout . Cancer
52 , 799 –801 .
6.
Graham
D. I.
(1992 ) Hypoxia and vascular disorders . In:
Adams
J. H.
Duchen
L. W.
(eds) Greenfield's Neuropathology , 5th edn. Edward Arnold, pp. 189 –90 .
7.
Hirano
A.
Zimmerman
H. M.
(1970 ) Some effects of vinblastine implantation in the cerebral white matter . Lab. Invest.
23 (3 ), 358 –67 .
8.
Jacobs
J. M.
Le Quesne
P.
(1992 ) Toxic disorders . In:
Adams
J. H.
Duchen
L. W.
(eds) Greenfield's Neuropathology , 5th edn. Edward Arnold, pp. 950 –51 .
9.
Kaplan
R. S.
Wiernik
P. H.
(1982 ) Neurotoxicity of anti-neoplastic drugs . Semin. Oncol.
9 , 103 –30 .
10.
Manelis
J.
Freundlich
E.
Ezekiel
E.
Doron
J.
(1982 ) Accidental intrathecal vincristine administration . J. Neurol.
228 , 209 –13 .
11.
Sander
S. G.
Tobin
W.
Henderson
E. S.
(1969 ) Vincristine induced neuropathy: a clinical study of fifty leukaemic patients . Neurology
19 , 367 –74 .
12.
Schochet
S. S.
Jr
Lampert
P. W.
Earle
K. M.
(1968 ) Neuronal changes induced by intrathecal vincristine sulfate . J. Neuropathol. Exp. Neurol.
27 , 645 –58 .
13.
Shepherd
D. A.
Steuber
C. P.
Starling
K. A.
Fernbach
D. J.
(1978 ) Accidental intrathecal administration of vincristine . Med Pediatr. Oncol.
5 , 85 –8 .
14.
Slyter
H.
Liwnica
B.
Herrick
M. K.
Mason
R.
(1980 ) Fatal myeloencephalopathy caused by intrathecal vincristine . Neurology
30 , 867 –71 .
