Abstract
Central nervous system (CNS) involvement in early (Rai Stage 0 and Stage 1) chronic lymphocytic leukemia (CLL) is rare, with only five cases reported. We present the sixth reported case, a 77-year-old male with a 4 year history of Stage 0 CLL who presented with sudden onset of diplopia and headache. Workup revealed a leukemic involvement of his CNS and he responded well to treatment with intrathecal (IT) methotrexate. After his third IT treatment, he developed a change in his mental status, consistent with a chemotherapy induced encephalopathy, which was effectively treated with IT hydrocortisone. In addition to the case presentation, we review the previously reported cases in an effort to determine any characteristics common among the Stage 0/1 CLL patients with reported CNS involvement.
References
Aug 1, 1976·Southern Medical Journal·I P Law, J Blom
Oct 15, 1989·Cancer·M GarofaloJ C Masdeu
Jan 1, 1986·Acta Haematologica·A K Singh, R P Thompson
Feb 15, 1987·Cancer·J CashM S Pollack
May 1, 1985·Cancer·K OshimiH Mizoguchi
Jan 1, 1996·Neurology·S C CramerD N Louis
Jun 5, 1998·Leukemia & Lymphoma·G Majumdar
Oct 10, 1998·Cancer Practice·C MorrisonI W Flinn
Citations
Dec 30, 2004·Cytometry. Part B, Clinical Cytometry·Grzegorz S NowakowskiClive S Zent
Aug 18, 2005·International Journal of Hematology·Jordi BrunaFrancisco Rubio
May 8, 2007·International Journal of Hematology·M KalacB Jaksica
Sep 26, 2013·Leukemia Research·Megan RattermanChadi Nabhan
Jul 16, 2005·Leukemia & Lymphoma·Martin Schmidt-HieberUlrich Keilholz
Sep 14, 2004·Leukemia & Lymphoma·Tadeusz RobakHalina Urbańska-Ryś
Oct 21, 2005·Leukemia & Lymphoma·Stefan KnopHolger Hebart
Nov 19, 2013·Leukemia & Lymphoma·Cédric RossiAnne-Sophie Michallet
Sep 14, 2007·Clinical Neurology and Neurosurgery·C P E LangeCh J Vecht
Sep 1, 2004·Journal of the Neurological Sciences·Ulrich HerrlingerMichael Weller
Jan 22, 2013·Clinical Lymphoma, Myeloma & Leukemia·Ohad BenjaminiMichael Keating
Dec 24, 2011·Clinical Lymphoma, Myeloma & Leukemia·Rodrigo Lopes da Silva
Nov 4, 2009·Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology·Tsunayuki KakimotoAkaru Ishida
May 1, 2018·Annals of Hematology·Nyanza K L M TimmersSaskia K Klein
Mar 8, 2019·The Oncologist·Alipi V Naydenov, Lynne P Taylor
Nov 10, 2007·Onkologie·Carmen D SchweighoferMarcel Reiser
Nov 20, 2016·British Journal of Haematology·Anne WanquetTherese Aurran-Schleinitz
Jul 20, 2011·Journal of Neuro-oncology·Alan A MoazzamSantosh Kesari
Jan 1, 2021·Journal of Blood Medicine·Takahisa NakanishiShosaku Nomura
Sep 15, 2014·BMC Research Notes·Simone Lima de SouzaMaria Helena Ornellas