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NEUROLOGY 1983;33:1032
© 1983 American Academy of Neurology

Paraparesis following intrathecal chemotherapy

A. F. Hahn, T. E. Feasby and J. J. Gilbert

Department of Clinical Neurological Sciences and Department of Pathology (Drs. Hahn and Gilbert), Victoria Hospital, and the Department of Clinical Neurological Sciences (Dr. Feasby), University Hospital, London, Ontario, Canada.

We studied a case of flaccid paraplegia that immediately followed intrathecal injection of cytosine arabinoside diluted in 1.5% bacteriostatic water (1.5% benzyl alcohol in H2O). The complication was reversed by rinsing the CSF space with saline. Autopsy showed fibrosis and remyelination of lumbosacral nerve roots. In acute and chronic animal experiments, we showed that benzyl alcohol in commercially used concentrations can have a local anesthetic and an irreversible toxic effect on nerve fibers. This provides a sufficient explanation for many cases of paraparesis following intrathecal chemotherapy.

Address correspondence and reprint requests to Dr. Hahn, Department of Clinical Neurological Sciences, Victoria Hospital, London, Ontario, Canada N6A 4F5.

Presented in part at the XVII Canadian Congress of Neurological Sciences, Toronto, June 23–26, 1982.

Accepted for publication December 6, 1982.




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