The central nervous system manifestations of leukemia: A report of 6 cases with meningeal involvement

Abstract

Summary The subject of central nervous systemmanifestations of leukemia is presented, and the literature reviewed briefly. Six cases of meningeal involvement complicating the course of leukemia are recorded and discussed. Five of these patients were treated with methotrexate, intrathecally, with relief of clinical manifestations. The intrathecal administration of methotrexate in doses of 5 mg. appeared to be more effective in relieving symptoms and eliminating abnormal spinal fluid changes than did spinal fluid drainage and/or roentgen therapy. Three intrathecal injections of methotrexate on alternate days seemed to be more efficacious and of more lasting benefit than one injection given as symptoms reappeared. The explanation for the increased incidenceof leukemic infiltration of the central nervous system would appear to be the prolongation of life by antileukemic drugs. Six of 37 children with leukemia (16.2 per cent) in this series developed this complication. Early recognition and prompt treatment may prevent undesirable results of prolonged increased intracranial pressure, including blindness. Whether prophylactic intrathecal injectionsof methotrexate at monthly intervals would yield better results than treatment when the complication has developed merits further investigation.