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A Case of Leukaemic Meningitis
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A Case of Leukaemic Meningitis
1.
Prof.K.H.NOORUL AMEEN’s Unit
Dr.E.Thirulogachandar
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4.
5.
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7.
8.
Cranial nerve right
left Olfactory N N Optic nerve-visual acuity field colour vision fundus 6/6 Equal Normal Papillodema+ 6/6 Equal Normal Papillodema+ 3,4 and 6 nerves- extraocular movements Light reflex Accomodation reflex weak Equal Convergence absent Weak Nystagmus+ Equal Convergence absent 5 th nerve Normal normal 7 th nerve normal LMN palsy 8 th nerve normal normal 9&10 th nerve weak weak 11 th nerve weak weak 12 th nerve - LMN palsy
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10.
11.
12.
13.
14.
CBC-Hb-9gm% 31/8/10
X ray chest PA view-normal TC-4200 ECG-WNL DC-P53L43E2 URINE R/E-NORMAL ESR-15/32 Na-142 MCV-77fl K -4.1 MCH-28.8 MCHC-33.5 SERUM-UREA-42mg/dl CREATININE-0.9mg/dl SUGAR-90 mg/dl
15.
16.
17.
18.
19.
20.
21.
LP CSF ANALYSIS
Sugar 51 mg/dl (2/3 ofblood sugar) Protein 225mg/dl (40-60mg/dl) Cell count Acellular C & S (for pyogenic) NO GROWTH Chloride 113mEq/L(Normal 95-114)) Gram’s Staining AFB staining No Organism seen Negative
22.
23.
24.
6/9 RPT CBC-Hb-11.0GM
10/9/10 CBC-HB-4.1GM TC-4200 TC-3200 DC-P48L52 DC-P50L48E2 ESR-2/5 ESR-28/52 PLT-1.0 LAC PLT-<20000 MCV-90.6 MCH-30.6 MCHC-31.2 RBC-3.4 Million RBC-1.55 Million PS STUDY -THROMBOCYTOPENIA PS STUDY-THROMBOCYTOPENIA
25.
26.
27.
HAEMATOLOGY-CBC-Hb-5.1 GM TC-7200
DC-P3L10Atypical cells87% PCV-15% ESR-45/95 PLATELETS-5000 PS STUDY-RBC-normocytic normochromic WBC-dec.neutrophils,atypical mononuclear cells PLT-REDUCED BMA –Dilute marrow,BLASTS-90%, Nuclear&cytoplasmic vacuolation ACUTE LEUKEMIA-ALL –L3
28.
29.
Copyright ©2007 American
Society of Hematology. Copyright restrictions may apply. Maslak, P. ASH Image Bank 2007;2007:6-00053 Figure 1. Blasts appear small with a thin rim of cytoplasm
30.
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34.
12-year-old boy with
acute lymphocytic leukemia presenting with severe headache
35.
AML ALL
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41.
Clinical features Feature
Children Adult Age (years) <1 2 — 1–9 72–78 — 10–19 20–26 — 20–39 — 55 40–59 — 36 ≥ 60 — 9 Male 56–57 62 Symptoms Fever 57 33–56 Fatigue 50 ? Bleeding 43 33 Bone or joint pain 25 25
42.
Lymphadenopathy
None 30 51 Marked (>3 cm) 15 11 Hepatomegaly None 34 65 Marked (below umbilicus) 17 ? Splenomegaly None 41 56 Marked (below umbilicus) 17 ? Mediastinal mass 8–10 15 CNS leukemia 3 8 Testicular leukemia 1 0.3
43.
CNS status*
paediatric adults CNS1 67–79/60 92–95 CNS2 5–24/27 ? CNS3 3/3 5–8 Traumatic lumbar puncture with blasts 6–7/10 ? Leukemic blasts in marrow (%) <90 33/46 29 >90 67/54 71 Leukemic blasts in blood Present 87/90 92 Absent 13/10 8
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