Cerebellar coning and uncal herniation in childhood acute leukaemia

188 cases of childhood leukaemia came to necropsy at Children's Hospital of Los Angeles between 1965 and 1978. The necropsy records show that cerebellar coning and/or uncal herniation occurred in 5 of 47 cases with central nervous system (CNS) leukaemia and in only 1 of 141 without meningeal or cerebral infiltration. A review of the 168 cases of acute lymphocytic leukaemia treated at the University Hospital, Kuala Lumpur, since 1968 revealed another instance of coning, which occurred in a patient with CNS leukaemia. 4 of these 7 children with coning and/or uncal herniation did not have papilloedema, and the diagnosis was made only at necropsy. Coning was recognized 48 h after lumbar puncture in 2 children. In the other 5 cases, there was no relation between coning and lumbar puncture. This life-threatening complication should be considered before patients with CNS leukaemia are subjected to lumbar puncture.