Schmidt-Hieber Martin, Thiel Eckhard, Keilholz Ulrich
Medizinische Klinik III, Charité-Campus Benjamin Franklin, Hindenburgdamm 30, D-12200, Berlin, Germany
Leuk Lymphoma. 2005 Apr;46(4):619-21. doi: 10.1080/14767050400029681.
Leukemic meningitis is a rare manifestation of chronic lymphocytic leukemia (CLL) and typically occurs in advanced stages. We report the case of a 71-year-old male in whom Binet A, Rai 1 stage CLL was diagnosed in June 2002. The stage called for a "watch and wait" strategy. Six months later the patient presented with paraparesis. Magnetic resonance imaging of the lumbar spine revealed no abnormalities. Lumbar puncture disclosed xanthochromic cerebrospinal fluid (CSF) with 1003 cells/microl, 95% atypical lymphocytes. Flow cytometry confirmed typical features of CLL. Intrathecal injections of methotrexate, cytosine arabinoside and corticosteroids did not substantially reduce the CSF cell count and failed to improve the neurological symptoms. Two weeks later the patient developed a pulmonary embolism complicated by fatal secondary pneumonia. Leukemic meningitis is a rare manifestation of CLL, especially in early stages. Selective spinal paraparesis as the first symptom of meningitis in CLL is even rarer and has been reported only once.
白血病性脑膜炎是慢性淋巴细胞白血病（CLL）的一种罕见表现，通常发生在晚期。我们报告一例71岁男性患者，2002年6月诊断为Binet A、Rai 1期CLL。该分期需要采取“观察等待”策略。6个月后患者出现双下肢轻瘫。腰椎磁共振成像未发现异常。腰椎穿刺显示脑脊液呈黄色，每微升有1003个细胞，95%为非典型淋巴细胞。流式细胞术证实为CLL的典型特征。鞘内注射甲氨蝶呤、阿糖胞苷和皮质类固醇并未显著降低脑脊液细胞计数，也未能改善神经症状。两周后患者发生肺栓塞，并并发致命的继发性肺炎。白血病性脑膜炎是CLL的罕见表现，尤其是在早期。选择性脊髓性双下肢轻瘫作为CLL脑膜炎的首发症状更为罕见，仅报道过一例。
