Central Nervous System Involvement by Leukemia in Children. I. Relationship to Systemic Leukemia and Description of Clinical and Laboratory Manifestations

Abstract

Observations on the course of 59 children who experienced 109 distinct episodes of CNS involvement by leukemia showed that: 1. This complication may be associated with all types of acute and subacute leukemia. 2. There is no single or combination of diagnostic criteria. Manifestations of increased CSF pressure, such as vomiting, headache, and papilledema are the most frequent clinical findings. However, it should be emphasized that CNS involvement may be associated with normal CSF findings. 3. CNS involvement may be present at the onset of leukemia or can occur at any time during the course. 4. Approximately 26 per cent of children with leukemia develop CNS involvement. 5. CNS involvement may occur when the disease is under apparently good therapeutic control as well as during relapse. 6. There is no relationship between the agents which had been previously used to treat the systemic disease and the later development of CNS involvement. However, the onset of CNS symptoms was less frequent when the systemic disease was under treatment with steroids. 7. The development of CNS involvement does not appear to shorten the survival time of patients with leukemia when treatment for CNS involvement is given.

EEG-Changes During Intensified Induction-Therapy of Acute Lymphoblastic Leukemia

“…So mostly malignant cells will be found in the CSF, long before rupture of the piaglial-membrane and infiltration of the brain parenchyma occur (Price and Johnson 1973). In 10-50 % of patients with clinical, electrophysiological or pathologic-anatomical evidence of lcukemic infiltration of brain or meninges, blast-cells can not be detected in the CSF (Hyman et al 1965, Fichsel and Schallah 1972, Crosley et al 1978). However, clinical and electroencephalographic signs of CNS-involvernent may occur, when blast infiltration is still confined to the leptomeninx (Hyman et al 1965).…”

“…In 10-50 % of patients with clinical, electrophysiological or pathologic-anatomical evidence of lcukemic infiltration of brain or meninges, blast-cells can not be detected in the CSF (Hyman et al 1965, Fichsel and Schallah 1972, Crosley et al 1978). However, clinical and electroencephalographic signs of CNS-involvernent may occur, when blast infiltration is still confined to the leptomeninx (Hyman et al 1965). This is probably due to compression of arachnoideal blood-vessels by dense blast-accumulations (Price and Johnson 1973).…”

“…increased following prolonged survival times (Hyman et al 1965, Price and Johnson et al 1973, Mittler et al 1974). Campbell et al 1977).…”

Computerized Axial Tomography in the Study of Intracranial Complications in Hematology

“…'*) Specific intracranial localizations, confirmed by histology, are rare. 12* 46 In an earlier study we found only 35 Among 17 patients presenting Hodgkin's disease, 15 had neuropsychic symptoms. Seven demonstrated abnormal intracranial images when examined with CAT.…”

Retrospective evaluation and prediction of clearance and toxicity of high dose methotrexate in childhood acute lymphoblastic leukemia patients

“…Samples over 1.00 μmol/L should be diluted into the scope of calibration curve (0.05-1.00 μmol/L) using dilution factor 10 , 100 or 1000. Method comparison was performed among modified EMIT assay, LC-MS/MS (liquid chromatography-tandem mass spectrometry) assay and commercial EMIT assay (Hyman et al, 1965).…”