Chronic Lymphocytic Leuchemia and Central Nervous System lnvasion

Abstract

Background: Central nervous system (CNS) involvement in early stage chronic lymphocytic leukemia (CLL) is very rare. The diagnosis is controversial particularly when it is associated with systemic diseases. Objective: In this paper, we report a patient with early stage CLL with CNS involvement who presented with contraversial laboratory and imaging findings and disease course. Findings: Neurologic examination revealed confusion and bilateral pyramidocerebellar signs. On blood smear and bone marrow aspiration lymphocytosis was identified. On magnetic resonance imaging (MRI), there were hyperintense lesions in the pons, cerebellar white matter, middle cerebellar pedincles and mesencephalon on T2 weighted images. Pontine lesion displayed prominent tumor-like contrast enhancement. Facal non-enhancing lesions were found in frontoparietal white matter as well. Conclusion: In early stage CLL patients any neurologic symptom and finding should be taken into consideration for probable CNS involvement. Further investigations such as radiofogic imaging and CSF evaluation are undoubtedly necessary.