Nursing the Leukemic Child with Central Nervous System Involvement

Abstract

AT LEAST ONE OUT of four children with acute leukemia develops central nervous system involvement. Infiltration of the meninges and brain with leukemic cells is being recognized with increasing frequency. This serious complication can occur at any stage of the disease, even when the child is in good hematologic remission. It is more apt to occur later in the course of the disease, however(1). Because it is impossible to predict which child will develop central nervous system involvement, close observation of all leukemic children is most important. Everyone who cares for these youngsters-nurses and parents alike-must be alert to sudden changes in the child's condition and be prepared for any emergency. The child may convulse suddenly, occasionally without warning. The symptoms to watch for include persistent nausea and vomiting, severe headaches, weakness of the extremities, unexplained lethargy, episodic irritability, various neurological manifestations such as ataxia, vertigo, ocular palsies, tinnitus, and rarely, voracious appetite and weight gain (2). Papilledema is an early sign. An electroencephalogram will disclose abnormal changes. Intrathecal methotrexate has been successful in the treatment of meningeal complications, and large effective doses can be administered by this route(3,4) . The physician who is about to initiate intrathecal methotrexate will need certain information: the child's weight in kilograms in order to compute the dosage of the drug; complete blood chemistries in order to evaluate renal function and if neces-