CNS Involvement in AML Patient Treated with 5-Azacytidine

Vasilatou, Diamantina; Papageorgiou, Sotirios; Bazani, Efthymia; Prasouli, Athina; Economopoulou, Christina; Roumpakis, Christoforos; Karakitsos, Petros; Dimitriadis, George; Pappa, Vasiliki

doi:10.1155/2014/937203

Cited by 2 publications

(5 citation statements)

References 11 publications

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“…The presence of certain factors has been associated with increased risk of neurological complication. These include hyperleukocytosis, high level of lactate dehydrogenase and high expression of CD56 [7]. In a single institution study of 290 pediatric patients with AML, the authors found significant relation between CNS involvement in patients with AML having the cytogenetic abnormality Inv 16, t [9], or AML M4 and M5 subtype.…”

Section: Discussionmentioning

confidence: 96%

“…The exact incidence of central nervous system (CNS) involvement in patients with AML is unknown, but is lower compared with the incidence in children and adults with ALL; for that reason routine CSF examination is not performed as part of the diagnostic workup in asymptomatic patients [6,7]. Involvement of the CNS may result acutely from the disease at the diagnosis, as in the index case; from relapse of the disease or from complications of agents used in treatment.…”

Section: Discussionmentioning

confidence: 99%

“…In symptomatic patients, the clinical picture will depend on which part of the CNS is involved. Features of advanced disease include irritability, headaches, seizures symptoms of raised intracranial pressure and cord compression [7,9]. Amongst the leukemia, AML is the most common leukemia to produce cord compression; however, it is a rare initial presentation of AML [4].…”

Section: Discussionmentioning

confidence: 99%

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Paraplegia as initial presentation of acute myeloid leukemia: A case report

Ladu¹,

Mohammed²,

Talba³

et al. 2017

IJCRI

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International Journal of Case Reports and Images (IJCRI) is an international, peer reviewed, monthly, open access, online journal, publishing high-quality, articles in all areas of basic medical sciences and clinical specialties.Aim of IJCRI is to encourage the publication of new information by providing a platform for reporting of unique, unusual and rare cases which enhance understanding of disease process, its diagnosis, management and clinico-pathologic correlations. Involvement of the central nervous system (CNS) may result acutely from the disease at the initial diagnosis, and the symptoms range from muscle weakness, paresthesias, and hypoesthesia to fecal and urinary incontinence. Paraplegia is an extremely rare initial presentation of undiagnosed leukemia. Case Report: A 15-year-old girl presented with acute urinary and fecal incontinence, and a day later developed inability to move both lower limbs. There was two weeks preceding history of fever, malaise and lower back pain, no associated history of paresthesias or numbness. Examination of both lower limbs revealed decreased tone and reflexes with bilateral extensor reflexes and power of 0/5. There was a loss of sensation around the perianal region with absent anal tone. Cranial nerve and sensory examination were normal. Both peripheral blood film and bone marrow aspiration cytology stained with Leishman stain were consistent with acute myeloid leukemia (AML) FAB M-4 subtype. Cerebrospinal fluid analysis was negative for malignant cells. Magnetic resonance imaging of the lumbosacral region was obtained; both T1-and T2-weighted sequences showed no signal intensity in the spinal cord, theca and cauda, with normal signal intensity involving the intervertebral disc. Patient was commenced on supportive therapy and induction chemotherapy using daunorubicin 45 mg/m2 days 1-3 and cytosine arabinoside 200 mg daily days 1-7. However, patient succumbed to her disease and passed away 10 days into treatment as a result of respiratory complication. Conclusion: Central nervous system involvement is a rare initial presentation of AML. Absence of abnormality on MRI scan does not rule out spinal cord involvement; consequently late recognition may delay treatment and lead to irreversible neurological complication.

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Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Paraplegia as initial presentation of acute myeloid leukemia: A case report

Ladu¹,

Mohammed²,

Talba³

et al. 2017

IJCRI

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“…In patients presenting with altered mental status, headache, visual disturbances, or other neurological symptoms, consideration should be made for leptomeningeal involvement. This is significant because leptomeningeal AML is associated with a poor prognosis and decreased rate of complete response, decreased disease-free survival, and decreased overall survival compared to absence of leptomeningeal disease [ 4 , 7 ]. The incidence of AML with central nervous system (CNS) involvement is lower than that of acute lymphoblastic leukemia (ALL), and thus routine lumbar puncture is not performed in the absence of neurological symptoms.…”

Section: Introductionmentioning

confidence: 99%

“…The incidence of AML with central nervous system (CNS) involvement is lower than that of acute lymphoblastic leukemia (ALL), and thus routine lumbar puncture is not performed in the absence of neurological symptoms. Disease relapse can sometimes occur from the CNS prior to relapse from the bone marrow [ 7 ]. It has been postulated that CNS prophylaxis for AML can improve survival, but this strategy is currently not used given the relatively low incidence of CNS involvement.…”

Section: Introductionmentioning

confidence: 99%

Acute Myeloid Leukemia Relapse Presenting as Complete Monocular Vision Loss due to Optic Nerve Involvement

Patel

2016

Case Reports in Hematology

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Acute myeloid leukemia (AML) involvement of the central nervous system is relatively rare, and detection of leptomeningeal disease typically occurs only after a patient presents with neurological symptoms. The case herein describes a 48-year-old man with relapsed/refractory AML of the mixed lineage leukemia rearrangement subtype, who presents with monocular vision loss due to leukemic eye infiltration. MRI revealed right optic nerve sheath enhancement and restricted diffusion concerning for nerve ischemia and infarct from hypercellularity. Cerebrospinal fluid (CSF) analysis showed a total WBC count of 81/mcl with 96% AML blasts. The onset and progression of visual loss were in concordance with rise in peripheral blood blast count. A low threshold for diagnosis of CSF involvement should be maintained in patients with hyperleukocytosis and high-risk cytogenetics so that prompt treatment with whole brain radiation and intrathecal chemotherapy can be delivered. This case suggests that the eye, as an immunoprivileged site, may serve as a sanctuary from which leukemic cells can resurge and contribute to relapsed disease in patients with high-risk cytogenetics.

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CNS Involvement in AML Patient Treated with 5-Azacytidine

Cited by 2 publications

References 11 publications

Paraplegia as initial presentation of acute myeloid leukemia: A case report

Paraplegia as initial presentation of acute myeloid leukemia: A case report

Acute Myeloid Leukemia Relapse Presenting as Complete Monocular Vision Loss due to Optic Nerve Involvement

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