Inadvertent intrathecal application of vindesine and its neurological outcome: case report and systematic review of the literature.

Introduction: Vinca alkaloids are used to treat a diversity of malignancies. Inadvertent intrathecal application is followed by severe neurological consequences, with fatal outcomes in the majority of the reported cases. Therapy of choice has been experimental.

Research question: What are the outcomes of inadvertent intrathecal application of vinca alkaloids and how should it be treated? What is the role of irrigation of the cerebrospinal fluid (CSF) in order to remove the vinca alkaloid and potentially toxic metabolites?

Material and methods: In this paper we report the case of a 53-year-old man who was, in the course of his treatment for acute lymphoblastic leukemia (ALL), inadvertently injected with vindesine intrathecally. The patient survived following aggressive and invasive treatment, which included irrigation of the CSF via external ventricular and lumbar drains. We also conducted a systematic review of similar published cases.

Result: A total of 31 cases with intrathecal inadvertent vinca alkaloid injection were identified. Including the case described in this report only two patients were injected with vindesine (n = 2, 6.5 %), all other received vincristine. Only 6/31 (19.4 %) patients survived the acute phase of the vinca alkaloid intoxication. 6/15 (40.0 %) patients receiving some sort of CSF irrigation survived (cf. 0/12 without irrigation therapy). All survivors were left with very significant neurological deficits.

Discussion and conclusion: The combined evidence suggests that intrathecal administration of vincristine is universally fatal without treatment, while CSF irrigation carries a chance of survival. Patients are, however, left with severe neurological deficits such as paraplegia.