Meet Inspiring Speakers and Experts at our 3000+ Global Conference Series LLC LTD Events with over 1000+ Conferences, 1000+ Symposiums
and 1000+ Workshops on Medical, Pharma, Engineering, Science, Technology and Business.

Explore and learn more about Conference Series LLC LTD : World’s leading Event Organizer

Back

29th International Conference on Psychiatry & Mental Health

Singapore City, singapore

Sangeeta Mudaliar

Sangeeta Mudaliar

Bai Jerbai Wadia Hospital for Children, India

Title: CNS involvement in pediatric leukemia/lymphoma and radiology findings

Biography

Biography: Sangeeta Mudaliar

Abstract

Central Nervous System (CNS) complications in leukemia and lymphoma can be divided in two broad categories viz. due to CNS disease and secondly, due to complications of the therapy. Rarely an unrelated or coincidental complication may be encountered. The aim is to characterize CNS complications and MRI findings observed in leukemia and lymphoma patients. A retrospective analysis of data of 558 leukemia and lymphoma patients registered over 7 years period at B J Wadia Hospital Mumbai. The total numbers of patients with CNS manifestation at the time of presentation, during therapy or follow-up were 59 (10%). Patients with primary involvement of CNS were 16/59 (15 with blasts in CSF and 1 patient with lymphoma had changes on MRI but CSF was negative for blasts), 23/59 had secondary involvement, 2/59 had CNS symptoms unrelated to leukemia and 19/59 had CNS leukemia during or after completion of therapy. 2 patients had isolated ophthalmic/orbital relapse. Clinical presentations were proptosis in 3/59 patients, headaches in 22/59 patients, seizures in 5/59 and encephalopathy in 11/59 patients. 19 patients were asymptomatic; all asymptomatic patients had blast in CSF at the time of diagnosis or relapse. 23 patients with secondary CNS involvement included 5 patients of sagittal sinus thrombosis, 2 viral encephalitis, 3 methotrexate induced encephalitis, 6 in press, hemorrhage and extensive thrombosis in 1 APML case, ocular tuberculosis, CNS granuloma, infarct, radiation induced secondary neoplasm, cytarabine induced encephalopathy and brain abscess in one case each. 2 patients who had CNS involvement unrelated to disease had neuro cysticercosis, one of them a case of AML presented with seizures 1 month after diagnosis, was not on therapy till then, the other presented after completion of ALL maintenance. Patients with secondary CNS involvement had typical findings on MRI like PRESS in 6 patients, Thrombosis in 6, Infarct and Brain abscess accounted for 1 each, MTX induced leuco-encephalopathy in 2 patients, meningioma in 1, multiple granuloma in 1 and encephalitis in 2 patients. The child with orbital TB, presented with proptosis and was initially thought to have relapse but correct diagnosis was based on histopathology report, JC virus was confirmed in CSF virology studies. It can be concluded that neurological complications may have varied presenting symptoms and imaging abnormalities. It is important to have appropriate inputs from clinicians regarding the drugs used and intensity of therapy received. Radiologist with these inputs helps in arriving at correct diagnosis. Most of the time correct diagnosis can be made based on clinical history and radiology findings. Histopathology or microbiologic diagnosis is required in some patients. Special considerations to tuberculosis and neuro cysticercoisis should be kept in mind in developing countries. Treatment becomes challenging in these patients as the concomitant chemotherapy can be more toxic. Patients in our centre presented with ocular TB, CNS TB and AML with neuro cysticercosis have successfully completed therapy and are on regular follow-up without CNS complications