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Chronic lymphocytic leukemia with hypothalamic invasion
M Garofalo1, R Murali, I Halperin
1Department of Neurology, St. Vincent's Hospital and Medical Center of New York, New York 10011.
Insights
A rare central nervous system complication occurred in a patient with chronic lymphocytic leukemia (CLL). Leukemic cells infiltrated the brain, causing a hypothalamic lesion and confusion, a manifestation not previously documented in CLL.
Area of Science:
- Neurology
- Hematology
- Oncology
Background:
- Chronic lymphocytic leukemia (CLL) is a hematologic malignancy characterized by the proliferation of mature B-lymphocytes.
- Central nervous system (CNS) involvement is uncommon in CLL compared to other leukemia types.
- This case highlights a rare presentation of CNS complication in a patient with CLL.
Observation:
- A patient with known CLL presented with new-onset headaches and confusion.
- A computed tomography (CT) scan revealed a hyperdense lesion in the hypothalamus, causing obstruction of the foramina of Monro.
- Leptomeningeal involvement was suspected due to the location and obstructive nature of the lesion.
Findings:
- Cerebrospinal fluid (CSF) analysis during surgical decompression identified leukemic cells.
- These cells exhibited monoclonal lambda B-cell markers, consistent with the patient's CLL.
- Peripheral blood analysis confirmed the presence of similar leukemic cells.
Implications:
- This case expands the known spectrum of CNS complications in chronic lymphocytic leukemia.
- It underscores the importance of considering CNS involvement in CLL patients presenting with neurological symptoms.
- Further research may be warranted to understand the mechanisms and frequency of CNS infiltration in CLL.
Abstract:
Headaches and a state of confusion developed in a patient with chronic lymphocytic leukemia (CLL). A computed tomography (CT) scan of the head showed a hyperdense lesion in the hypothalamus with obstruction of the foramina of Monro. Leukemic cells with monoclonal lambda B-cell markers were identified in the ventricular fluid at the time of surgical decompression. Similar cells were identified in the peripheral blood. This lesion has not been described as a complication of CLL, a disease that, unlike other leukemias, rarely has central nervous system manifestations.