Spinal cord compression by epidural involvement over 21 vertebral levels in acute lymphoblastic leukemia.
Spinal cord compression is a rare complication of acute lymphoblastic leukemia (ALL). We report a 13-year-old boy with B-precursor ALL, presenting with restriction of breathing and back pain. Cerebrospinal fluid examination showed extremely high protein levels. Radiologic examination indicated that leukemia extended from the thoracic to sacral epidural spaces over 21 vertebral lengths in a band-shaped form, threatening to induce compressive spinal cord neuropathy. Prompt initiation of systemic chemotherapy relieved the obstruction of cerebrospinal fluid flow without local irradiation or surgical intervention. To our knowledge, this patient has shown the most extensive epidural involvement among ALL patients previously reported.
Isome
Ken-ichi
K
Department of Pediatrics, Nishi-Kobe Medical Center, Kobe, Japan.
Matsubara
Kousaku
K
Taki
Tomohiko
T
Nigami
Hiroyuki
H
Yura
Kazuo
K
Iwata
Aya
A
Wada
Tamaki
T
Taniwaki
Masafumi
M
Fukaya
Takashi
T
D000293:Adolescent; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D003520:Cyclophosphamide / Q000008:administration & dosage; D003561:Cytarabine / Q000008:administration & dosage; D003907:Dexamethasone / Q000008:administration & dosage; D004317:Doxorubicin / Q000008:administration & dosage / Q000031:analogs & derivatives; D015174:Epidural Neoplasms / Q000150:complications* / Q000188:drug therapy / Q000473:pathology; D006801:Humans; D008159:Lumbar Vertebrae; D008297:Male; D008727:Methotrexate / Q000008:administration & dosage; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000150:complications* / Q000188:drug therapy / Q000473:pathology; D011239:Prednisolone / Q000008:administration & dosage; D012445:Sacrococcygeal Region; D013117:Spinal Cord Compression / Q000188:drug therapy / Q000209:etiology*; D013904:Thoracic Vertebrae; D014750:Vincristine / Q000008:administration & dosage
D003561:Cytarabine; D014750:Vincristine; D003907:Dexamethasone; D004317:Doxorubicin; D003520:Cyclophosphamide; D011239:Prednisolone; C027260:pirarubicin; D008727:Methotrexate