Analysis of 5-year-follow-up of pediatric blood oncology patients with intrathecal injection of methotrexate mixed microcontent vincristine

Abstract

Objective To analyze the clinical manifestation, auxiliary examination, treatment, prognosis of 16 cases who experienced inadvertent injection of intrathecal microcontent vincristine, and and they were followed up for 5 years. Methods To collect detailed medical record material for 5 years of 16 pediatric blood oncology patients who appeared with nervous system damage symptoms caused by inadvertent administration of microcontent vincristine intrathecally, combined with subsequent visits at the clinic, or through telephone and letters followed-up. Results Clinical manifestations of lumbosacral radicular dysfunction were found in all 16 cases, among them 2 cases also had cervicothoracic radicular damage symptoms.The first sign was weakness in lower limbs, subsequently, walking difficulty.Cerebrospinal fluid protein was higher than normal in 3 cases.Magnetic resonance imagine of the brain and spinal cord revealed demyelination in the white matter of 2 cases.Electromyographic revealed neurogenic damage and showed complete or partial denervation changes in 11 cases that received this examination.After the treatment consisted of medication use to improve nerve nutrition metabolism and promote nervous function recovery, combined with positive rehabilitation therapy, 13 cases had improvement from level Ⅰ to Ⅲ in myodynamia.Of 9 cases with neurogenic bladder, 4 cases were back to normal, 3 cases were improved to different extent.Till Oct.2012, 6 cases lived in remission, 9 cases including 6 cases of recurrence died of the primary disease or complication in the treatment process, and 1 case died of penicillin anaphylactic shock almost 1 year after chemotherapy. Conclusions Inadvertent intrathecal injection of microcontent vincristine can cause lumbosacral radicular dysfunction.Trace amounts of vincristine intrathecally cumulative can also cause serious damage to the nervous system.The early application of hormone and nerve nutrition drugs combined with positive rehabilitation therapy have surely curative effect to alleviate the neuropathy for inadvertent administration of microcontent vincristine intrathecally. Key words: Leukemia; Vincristine; Intrathecal administration; Rehabilitation therapy; Child