Paraplegia following chemonucleolysis. A case report and discussion of neurotoxicity.

A case report of inadvertent chymopapain introduction into the lumbar theca is reported. It led to an extensive subarachnoid and subdural hemorrhage, producing paraplegia. The neurotoxicity of chymopapain in the experimental model is reviewed and related to a clinical setting. Clinically speaking, there appears to be no tolerance for this discolytic agent either in the peripheral or central nervous system. Cerebrospinal fluid barbotage may lessen the neurologic injury by removing the enzyme when it finds its way inadvertently into the subarachnoid space.