What is a Lesion of the Nervous System?
Metastasis to the meninges, brain matter and nerve trunks can complicate the course of any hemoblastosis, however, it is more common in children with acute lymphatic regional leukemia. So far, no fundamental differences have been noted during neuroleukemia with different leukemia and in its response to treatment.
In recent years, according to pathological data, the frequency of neuroleukemia in acute lymphoblastic leukemia in children has increased significantly, approximately 75%. According to clinical data (Kurmashov V.P., Koshel I.V.), in groups of children who did not receive specific prophylaxis, the frequency of neuroleukemia is about 65%. The most common neuroleukemia occurs in young children, under 15 years old. The metastatic nature of neuroleukemia was proved by direct methods of chromosomal analysis by Mastrangelo and co-authors back in 1970, who revealed the same chromosome changes in the cells of the cerebrospinal fluid as in the bone marrow cells. Skidding and fixation of cells in the meninges occur at the earliest stages of the disease. This is evidenced by the fact that the achievement of improvement during the first 3-4 weeks after detecting acute lymph regional leukemia in a child does not prevent the development of neuroleukemia. And an attempt to delay the radical prevention of neuroleukemia against the background of the improvement achieved will lead to its outbreak, while the preventive introduction of methotrexate into the spinal canal against the background of remission induction and after it will delay the appearance of neuroleukemia.
Symptoms of a Nervous System Damage
Neuroleukemia is usually characterized by meningeal syndrome; in this case, a headache initially appears, and only then nausea and vomiting. The above symptoms often grow slowly, usually taken for random, associated with errors in the mode, in the diet. In other cases, without any signs of meningeal syndrome, the child’s behavior changes: he becomes capricious, irritable, lethargic, uncommunicative. The study often reveals congestion of the fundus, stiff neck, Kernig symptom, impaired cranial nerve function.
It should be noted that in these cases with spinal puncture, high blast cytosis (high content of cellular elements) in the fluid is already found.
The above picture refers to the most common form of neuroleukemia – the defeat of the membranes, intracerebral tumors are much less common. The patient becomes lethargic, complains of a headache. Focal neurological
symptomatology is associated with the localization of the tumor. With an intracerebral tumor, stagnation of the fundus, an increase in protein in the cerebrospinal fluid with a normal content of cellular elements — protein-cell breakdown, are noted. The pathological focus on the EEG and the displacement of the M-echo in the direction opposite to the location of the tumor.
Quite a rare debut of neuroleukemia is an isolated lesion of the cranial nerves, in particular the oculomotor, auditory and visual. Neurological symptoms are characterized by double vision, impaired eyeball movement, decreased vision on the affected side, often to complete blindness. As well as developing atrophy of the optic disc, noted in the study of the fundus. It is also possible damage to the facial nerve with flaccid paresis of the facial muscles on the affected side. In this case, the composition of the cerebrospinal fluid may remain normal, or blast cytosis is found in it, indicating the involvement of the meninges.
Quite often, the terminal stage of acute leukemia is complicated by radicular syndrome, due to the infiltration of the corresponding roots by leukemia cells, or compression of the vertebrae as a result of a pathological fracture. Infiltration of the substance of the spinal cord is also possible, giving, like a typical spinal tumor, paresis of the legs with conductive disorders of sensitivity and pelvic disorders. In the cerebrospinal fluid, along with an increase in protein, blast cytosis is not uncommon.