Leukaemic meningitis in chronic lymphocytic leukaemia

A patient with chronic lymphocytic leukaemia (CLL) who developed leukaemic meningitis, after chemotherapy had successfully reduced the tumour load, is described. This progressed rapidly as basal meningitis and caused almost a complete obstruction of the lateral ventricles, palsy of several cranial nerves and deep coma. The diagnosis of leukaemic meningitis was nevertheless considerably delayed, as other forms of lymphocytic meningitis were excluded. Intrathecal methotrexate, followed by cranial irradiation led to complete resolution of neurological signs and symptoms and a rapid clearance of CSF of leukaemic cells. It is likely that immunological characterization of the CSF lymphocytes would help early diagnosis of such patients.