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MTX鞘内注射已广泛用于防治脑膜白血病,虽有并发脑脊髓病的报告,但均因同时存在脑膜白血病,或接受颅脑照射,未能确定其确切病因。本文报告1例2岁男孩,于1975年3月因急性白血病住院,经6周疗程的VCR、Pred、6-mpMTX诱导缓解,及MTX(6.5毫克/周×3)作预防性鞘内注射,并以MTX、Pred、6-mp,及每月静脉注射VCR鞘内注射MTX(6.5mg)作为维持治疗,未给予放疗。CSF在第五次鞘内注射时(1975年6月25日)仍正常,6月26日出现易激、诉背痛、拒绝走路。神经系统检查见颈项强直,尿潴溜、下肢肌肉软弱,随后瘫痪加重延及上肢,下肢痛觉减退。出现神经系统症状后第八天CSF检查细胞数36个/毫米~3、蛋白49毫克/分升,骨髓象正常,周围血未见幼稚
Intrathecal injection of MTX has been widely used in the prevention and treatment of meningococcal leukemia, although there are concurrent reports of cerebrospinal myopathy, but both due to the presence of meningococcal leukemia or brain irradiation, failed to determine the exact cause. This article reports a 2-year-old boy hospitalized for acute leukemia in March 1975 with VCR, Pred, 6-mpMTX for 6 weeks, and prophylactic intrathecal injection of MTX (6.5 mg / week × 3) And MTX, Pred, 6-mp, and monthly intravenous injection of VCR intrathecal injection of MTX (6.5mg) as maintenance therapy, did not give radiotherapy. CSF was still normal on the fifth intrathecal injection (June 25, 1975) and was irritable on June 26 with a back pain and refused to walk. Nervous system examination, see neck stiffness, urinary retention slip, lower extremity muscle weakness, followed by increased paralysis and extension of lower extremity pain relief. On the eighth day after onset of neurological symptoms, the number of CSF-tested cells was 36 cells / millimeter to 3, the protein was 49 mg / dL, the bone marrow was normal and no peripheral blood was found