Subendocardial Myocardial Infarction, Paraplegia and Cortical Blindness Possibly Related to Vincristine Treatment of Lung Cancer

A 63-year-old male was diagnosed as having small cell carcinoma (c-T4N3M0) and complete remission was achieved by 2 courses of chemotherapy with a carboplatinetoposide regimen.After 5 months, he relapsed and was treated with carboplatin (300mg/m2, on day 1), etoposide (100mg/m2, on days 1, 2, 3) and vincristine (1.0mg/m2, on day 1).Subendocardial myocardial infarction, paraplegia and cortical blindness developed 10 days after vincristine treatment.ECG showed ST-segment elevation in V4 to V6 and echocardiography revealed decreased motion of the anterior wall.The paraplegia was accompanied by lost of deep sensation and dysuria leading to a cordal infarction at the Th12, diagnosed by MRI.The cortical blindness may have been due to a cerebral infarction in the posterior cerebral artery, but brain CT and MRI results were normal. The cortical blindness abated within about 1 month. The onset of these symptoms was synchronous, suggesting that the myocardial infarction, paraplegia and cortical blindness were associated with vincristine treatment.