Infiltration of brain parenchyma

Introduction Central nervous system leukemia (CNSL), referred to as "brain white", is caused by leukemia cells infiltrating into the meninges or brain parenchyma, causing patients to exhibit corresponding neurological and/or psychiatric symptoms. Brain white can be seen at any stage of the course of leukemia. Central nervous system leukemia is rare in patients with brain parenchymal infiltration.

Cause

This type of leukemia often has abnormalities in the nervous system as the first symptom, and peripheral blood, bone marrow and cerebrospinal fluid do not change significantly in the early stage of the disease. It is extremely easy to miss diagnosis and misdiagnosis, delaying the best period of treatment.

an examination

Related inspection

Brain CT examination brain MRI examination brain nerve examination EEG examination

The diagnosis of "brain white" is mainly based on the following points

(1) Symptoms and signs with corresponding central nervous system involvement.

(2) Cerebrospinal fluid: increased pressure > 200 mm water column; white blood cell count in cerebrospinal fluid > 0.01 × 109 / L; cerebrospinal fluid protein qualitative test is positive or protein quantification > 45 mg / dl; leukemia cells can be found in cerebrospinal fluid.

(3) Excluding neurological diseases caused by other causes. Among the above, the most diagnostic significance for finding leukemia cells in cerebrospinal fluid.

Differential diagnosis

1. The most important need to identify is that CNS-L is the first manifestation of leukemia, and the proportion of missed diagnosis is very high. Diseases that cause elevated intracranial pressure and CSF similar to CNS-L changes include viral meningitis or encephalitis, tuberculous meningitis, cysticercosis (cysticercosis) and brain metastases. Identification point:

1 The presence of leukemia positive signs, peripheral blood or bone marrow examination confirmed the presence of leukemia.

2 As long as the possibility of leukemia is thought, the CSF should be cytologically examined, but in most cases it is easily overlooked and missed.

3 virus serological detection of related antibodies, CSF found acid-fast bacilli, cystic skin test positive and serum antibody detection and primary tumor findings are conducive to the diagnosis of non-CNS-L. In addition, tuberculous meningitis, often accompanied by pulmonary miliary tuberculosis, imaging examination can aid diagnosis.

Patients with definite leukemia have clinical manifestations of CNS and abnormal CSF changes during the course of the disease, and occasionally need to be differentiated from tuberculous or fungal meningitis:

1 In tuberculosis or fungal infection, the increase in protein and sugar in CSF is much greater than CNS-L.

2 pathogen examination, infected people can sometimes find fungi, in a few cases, acid-fast bacilli can also be found, while CNS-L can detect leukemia cells.

3 Intrathecal injection of anti-leukemia drugs, CNS-L often quickly improved, and infected people are ineffective.

2. High-dose cytarabine treatment can produce neurotoxicity, especially the clinical manifestations of cerebellar damage. According to medication and CSF examination is not difficult to identify. In addition, repeated intrathecal injection of chemical arachnoiditis, as well as leukoencephalopathy after cranial radiotherapy, sometimes need to be identified with CNS-L, and difficult to distinguish. Repeated CSF detection of leukemia cells negative, CNS-L may be less recurring. After the intrathecal injection is stopped, it gradually improves, and the recurrence of CNS-L can be basically ruled out.

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