Leukemia (CNS manifestations)

Changed by Henry Knipe, 6 Jun 2018

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Leukaemia CNS manifestations can be divided into those related to the disease itself and those associated with its treatment. Leukaemias are haematologic malignancies in which occur a proliferation of haematopoietic cells at an undifferentiated or partially differentiated stage of maturation ¹.

CNS manifestations directly attributed to leukaemia

leukaemic meningitis
intradural spinal involvement
granulocytic sarcoma (chloroma)
haematologic and cerebrovascular complications
- cerebral haemorrhage
  - most common in acute leukaemia ²
  - disseminated intravascular coagulation: multiple small haemorrhages in subcortical white matter ¹
  - also due alterations in coagulation factors, thrombocytopenia, and leukocytosis ²
- dural venous sinus thrombosis
CNS infections due immunosuppression (e.g. CNS aspergillosis and neurocandidiasis)
bone marrow infiltration: fat is replaced by leukaemic elements ³
ocular manifestations
- retinal haemorrhage

Leukaemia treatment-related CNS complications

chemotherapy
- drug-induced PRES ¹
- methotrexate neurotoxicity
  - aseptic meningitis
  - transverse myelopathy
  - stroke-like syndrome
  - demyelination and leukoencephalopathy
- CNS infections due to immunosuppression (e.g. CNS aspergillosis and neurocandidiasis)
radiation therapy
- radiation-induced neoplasms (e.g. meningioma, glioma and sarcoma)
bone marrow transplantation

~~-<li>ocular manifestations<ul><li>retinal haemorrhage</li></ul>~~
+<li>ocular manifestations<ul>
+<li>retinal haemorrhage</li>
+<li>leukaemic infiltration of the <a title="Optic nerve" href="/articles/optic-nerve">optic nerve</a> <sup>4</sup>
+</li>
+</ul>
~~-<a href="/articles/cns-infectious-diseases">CNS infections</a> due immunosuppression (e.g. CNS aspergillosis and neurocandidiasis)</li>~~
+<a href="/articles/cns-infectious-diseases">CNS infections</a> due to immunosuppression (e.g. CNS aspergillosis and neurocandidiasis)</li>

References changed:

4. Randhawa S, Ruben J. Leukemic Optic Nerve Infiltration. (2017) Ophthalmology. 124 (3): 277. <a href="https://doi.org/10.1016/j.ophtha.2016.08.002">doi:10.1016/j.ophtha.2016.08.002</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/28219495">Pubmed</a> <span class="ref_v4"></span>

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