Dorsal column myelopathy following intrathecal chemotherapy for acute lymphoblastic leukemia

A 42-year-old female with T-cell ALL developed a myelopathy primarily involving the dorsal columns after intrathecal chemotherapy. Within 24 hours of intrathecal chemotherapy, she experienced ascending lower limb numbness and balance issues, progressing to an inability to walk. MRI abnormalities were initially absent but later showed abnormal signal in the posterior cord, diffusely involving the lower cervical cord through the conus medullaris.

• 1
  The patient developed ascending, symmetric circumferential numbness in both lower limbs within 24 hours of intrathecal chemotherapy.
• 2
  MRI revealed abnormal high T2 and STIR signal in the posterior cord, primarily localized to the posterior columns but with some involvement of the central cord.
• 3
  Dermatomal SEP (DSEP) studies correlated better with the clinical sensory examination than MRI findings, demonstrating sensory deficit below T5.