Neuroleukemia occurs in 50% of Acute Lymphocytic Leukemias (ALL) and 10-12% of Acute Myelocytic Leukemias (AML) cases, condition neuroprophylaxis is not known the length of with initial therapy.
Pathological lesions contain access by leukemic cells, blood loss and demyelination. Inside addition, drug toxicity, behind penalty of irradiation and occlusion of clever microcirculation unpaid to leukostasis add to the total neurological depiction. When the leptomeninges are infiltrated, CSF shows the presence of a big numeral of blast cells, increase in protein and augmented weight and this may exist false intended for meningitis. Neuroleukemia may evident throughout remission, before this may yet be alive the presenting symptom in some.
Clinical facial appearance may exist those of meningitis raised intracranial tension with papilledema, trance, blackout, central neurological symptoms like convulsions otherwise paralysis, cranial nerve palsies, spinal rope or else spinal cause compression, otherwise intracranial blood loss. Sometimes hyperviscosity syndrome develops because of awfully far above the ground leucocyte counts (above 200 X 109/liter- 200,000/cmm). Symptoms of cellular hyperviscosity include aural and visual turbulence, ataxia, headache, profound stupor and coma. Leucapheresis relieved these symptoms dramatically.
Neuroprophylaxis
It is ongoing after achieving remission and is a must in acute lymphatic leukemia. Intrathecal methotrexate in a dose of 10-12 mg/m2 should exist agreed twofold a week intended for a total of 6 doses. A solitary dose ought to not exceed 15 mg. An other is cytosine arabinoside 50 mg intrathecally agreed two times a week meant for 6 doses.
Another modality of treatment is irradiation more than the CSF cisterns with a total dose of 2000 to 2400 rads over a period of 16-23 days. Treatment of reputable neuroleukemia is less successful. Cranial otherwise craniospinal irradiation mutual with intrathecal methotrexate or cytosine arabinoside is the method of choice.
Testicular leukemia
The testes may exist enlarged, solid and tender before the involvement might subsist clinically inapparent. Affection of the testes may happen sooner than, throughout before after the induction therapy. Testicular involvement leads on to relapse. Treatment of testicular scratch is by irradiation with 1000-2000 rads over a period of 2-10 days. Prophylactic irradiation of the testes has been tried in a quantity of centers, other than the lofty incidence of sterility restrictions its routine application.
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