An 18-year-old woman was admitted to the Hematology Department of the Hospital del Salvador due to a common ALL (positivedelphia negative).
She received chemotherapy ALL 15-30 according to the national protocol.
The induction produced a good response, achieving complete remission, followed by consolidation therapy with IQ (Metrotrexate 15 mg, Cytarabine 50 mg and Betamethasone 4 mg).
At the sixth month, headache and vision loss appeared during the stage of presentation.
Neuro-ophthalmic examination showed papilledema of the right eye, magnetic resonance imaging (MRI) thickening of the optic nerve.
The myelogram shows 50% lymphoblasts, the ocular symptoms were interpreted as an early relapse.
Rescue therapy (R1 scheme) was initiated, with triple intrathecal chemotherapy associated, biweekly.
After the second intrathecal inoculation, the patient complained of lower limb paresthesia (LLEE) and urinary incontinence.
Neurological examination showed a vigilant, active patient, with conserved language, decreased visual acuity of the right eye, proprioceptive deficit and weakness of the lower extremities, present osteotendinous reflexes (bilateral Babinski).
Absence of upper limb involvement (ULES).
MRI of the spinal cord showed hyperintensity of the posterior cord from cervical to lumbar and hyperintensity of the cauda equina.
After the first week, paraparesis was induced by a refractive paraplegia with a level D9 tactile hypoesthesia.
Thiamine 90 mg q12h, Pyridoxyne 150 mg q12h, Leucovorin 50 mg q12h, Cyanococcyme adenosmp c/24 h, Meteonine ytion
On the sixteenth day, a sensory level was defined at D6 and the WOR were universally abolished, although there were no motor or cognitive impairments in the upper limbs or in the cranial nerves.
On the twenty-sixth day the patient expressed persistent burning pain, weakness of both arms and occipital headache.
Angio-CT of the brain showed no abnormalities.
The CSF had: Prot: 0.79 g/L; Gluc: 0.57 mg/L; leukocytes: 74 per ul.
MRI of the spinal cord showed, in addition to the hyperintensity of the posterior cords, that of the lateral cords.
On the thirtieth day she developed tetraplegic fever and dysphagia. The next day she developed dyspnea due to respiratory failure and died in the afternoon.
