Vocal cord paralysis during the treatment of mantle cell lymphoma with vincristine

Abstract

Vincristine may cause peripheral, autonomic and cranial neuropathies. However cranial nerve involvement is quite uncommon.

Vincristine‐induced neuropathy: Atypical electrophysiological patterns in children

“…We did not expect to observe a motor mononeuritis multiplex pattern, because this presentation is infrequent in children. LD neuropathies are usually more common, although fibular mononeuropathies, vocal cord paralysis, and facial palsy have been described in children. These presentations are exceptional in adults .…”

“…Weakness may appear later, affecting muscles of the upper and lower limbs . Cranial neuropathy is rare but has been reported . Several studies have described the clinical and electrophysiological characteristics of vincristine‐induced neuropathies, but those studies were done at a time when doses of vincristine were higher than those given today .…”

The first reported case of vincristine‐induced unilateral vocal cord palsy in an adult patient with HIV‐associated Burkitt‐like lymphoma being treated with dose‐escalated R‐EPOCH

“…The majority of cases of vincristine‐induced VCP have been reported in the pediatric population . Very few cases have been reported in the adult population .…”

“…One case study reported an older male with mantle cell lymphoma, who developed hoarseness due to bilateral VCP after the second cycle of chemotherapy with R‐CHOP. Vincristine was omitted from subsequent cycles of chemotherapy and he had full recovery of the VCP and had attained complete remission …”

“…It is a dose‐dependent effect that typically occurs early in the course of treatment and while the pathogenesis of vincristine‐induced neuropathy remains unclear it may be related to an effect on microtubules resulting in malorientation of microtubules and neurofilaments . Recurrent laryngeal nerve palsy resulting in vocal cord palsy (VCP) caused by vincristine has also been reported in literature, predominantly in the pediatric population . Instant recognition and management of vincristine‐induced VCP is crucial because it is a potential fatal complication albeit one that can be completely reversed.…”