Advanced

AJNR - American Journal of Neuroradiology

This Article Figures Only Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by Fortin, D. Articles by Neuwelt, E. A. Search for Related Content PubMed PubMed Citation Articles by Fortin, D. Articles by Neuwelt, E. A.

American Journal of Neuroradiology 20:1794-1802 (11 1999)
© 1999 American Society of Neuroradiology

ARTICLE

Unusual Cervical Spinal Cord Toxicity Associated with Intra-arterial Carboplatin, Intra-arterial or Intravenous Etoposide Phosphate, and Intravenous Cyclophosphamide in Conjunction with Osmotic Blood Brain–Barrier Disruption in the Vertebral Artery

David Fortin^a, Leslie D. McAllister^a, Gary Nesbit^a, Nancy D. Doolittle^a, Michael Miner^a, E. Jerome Hanson^a and Edward A. Neuwelt^,a

^a From the Departments of Neurology (D.F., L.D.McA., N.D.D., E.A.N.) and Radiology (G.N.), Oregon Health Sciences University, Portland, OR; the Division of Neurosurgery, Ohio State University, Columbus, OH (M.M.); and Trinity Lutheran Hospital, Kansas City, MO (E.J.H.).

BACKGROUND AND PURPOSE: When the clinical and radiologic characteristics of an unusual cervical spinal cord complication of intra-arterial (IA) chemotherapy with blood brain–barrier (BBB) disruption in the vertebral circulation are documented. Seven cases are reported and analyzed in search of a pathophysiologic explanation.

METHODS: We retrospectively identified 94 patients who received a total of 380 standardized regimens of IA carboplatin, IA or IV etoposide phosphate, and IV cyclophosphamide infusion in conjunction with osmotic BBB disruption of the vertebral artery. We describe seven of those patients in whom unexpected neck pain developed followed by neurologic symptoms primarily in the upper extremities.

RESULTS: The symptoms correlated with MR abnormalities (T1 hypointensity, T2 hyperintensity, and unusual contrast enhancement) in the cervical spinal cord, usually involving the gray matter. The neurologic deficits and MR changes were generally transient. One patient who received a flu vaccination 48 hours before the chemotherapy incurred progressive myelitis and expired.

CONCLUSION: The pathophysiology of this complication is probably multifactorial but may be related to vascular streaming and an atypical inflammatory toxic reaction to carboplatin and etoposide. The complication has not recurred during a 6-month period following modification of the protocol.

This article has been cited by other articles:

				D. Fortin, J. A. Salame, A. Desjardins, and A. Benko Technical Modification in the Intracarotid Chemotherapy and Osmotic Blood-Brain Barrier Disruption Procedure to Prevent the Relapse of Carboplatin-Induced Orbital Pseudotumor AJNR Am. J. Neuroradiol., May 1, 2004; 25(5): 830 - 834. [Abstract] [Full Text] [PDF]