Neuropathologic Effects of Intrathecal Water

Abstract

In attempting to control the pain of disseminated carcinoma, a variety of agents has been injected intrathecally. This report deals with the neuropathologic changes in spinal roots and spinal cord of four patients into whose lumbar sacs 100 to 285 ml of distilled water was infused. Survival following the procedure ranged from 9 to 50 days. In the most severely affected case (285 ml instilled 50 days prior to death) the abnormalities were: (1) severe breakdown of axons and myelin sheaths of the lower cauda equina and to a lesser extent of other roots at levels as high as the eighth cervical segment, (2) severe central chromatolysis of anterior horn cells in lumbo-sacral spinal cord with milder degrees of change in the thoracic and lower cervical spinal cord, and (3) striking vacuolar change and axonal swelling, primarily in the lateral columns ascending as high as the lower cervical spinal cord. A second case (140 ml instilled 24 days prior to death) showed similar but milder changes. The remaining cases (100 ml instilled 34 days prior to death: 100 and 200 ml instilled 27 and 9 days prior to death) showed no changes referable to intrathecal water. Infusion of distilled water intrathecally is capable of producing distinctive lesions of spinal root and cord.