Intrathecal vincristine sulfate is a highly toxic agent that should never be administered intrathecally. The primary therapeutic action of vincristine sulfate is inhibition of microtubule (the cell structures that move chromosomes during mitosis (cell division)) production within the cell. This accounts for its direct neurotoxicity as a result of destruction of the neuronal cytoskeleton. Numerous case reports and a few literature reviews provide a well-described course of adverse effects following accidental intrathecal administration. The typical course is characterized by ascending paralysis eventually including respiratory paralysis and death from complications thereof. The published literature provides data on dozens of cases involving intrathecal administration of vincristine sulfate. Nearly all cases resulted in death within days to weeks, with the few survivors left paralyzed and/or in a coma or persistent vegetative state. This dismal prognosis is true even in cases of prompt recognition and initiation of therapeutic irrigation.
Intrathecal vincristine sulfate medical expert witness specialties include oncology, forensic pathology, toxicology, and neurology.