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Leukemic meningitis

Case contributed by Dr Bruno Di Muzio

Presentation

Seizures in a patient treating for acute lymphoblastic leukemia (ALL).

Patient Data

Age: 9
Gender: Female

MRI Brain

MRI

There is diffuse pachymeningeal thickness and enhancement involving both the brain and cerebellum. The ventricles are mildly enlarged for the patient age. Right posterior burr hole associated a deviation catheter that cross the septum pellucid and has its extremity on the left lateral ventricle. 

MRI Brain (3 months later)

MRI

There is disease progression characterized by thickness and enhancement of both the dura and leptomeninges. Cerebellum signal is increased and heterogeneous probably due to the leptomeningeal thickness. 

Ventricles have showed a marked reduction in their dimensions. 

Case Discussion

This child is under chemotherapy treatment for acute lymphoid leukemia (LLA). CNS involvement is uncommon in the presentation of LLA and it is more likely to be seen in the relapse of the disease after initial treatment. 

In patients like this one, the differential diagnosis is made between infection vs. carcinomatosis (LLA leptomeningeal disease). 

CSF cytology and microbiology confirmed the diagnosis of leukemic meningitis (leptomeningeal disease), in keeping with the radiographic findings and clinical data.

 

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