RT Journal Article SR Electronic T1 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 JF American Journal of Neuroradiology JO Am. J. Neuroradiol. FD American Society of Neuroradiology SP 1794 OP 1802 VO 20 IS 10 A1 David Fortin A1 Leslie D. McAllister A1 Gary Nesbit A1 Nancy D. Doolittle A1 Michael Miner A1 E. Jerome Hanson A1 Edward A. Neuwelt YR 1999 UL http://www.ajnr.org/content/20/10/1794.abstract AB 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.