Abstract
A 48-year-old man developed the infiltration of the leukemic cells in the central nervous system (including bilateral optic nerves) and cervical, brachial, and lumbar plexus one year and three months after the beginning of the therapy for acute leukemia (acute myelom-onocytic leukemia). Headache disappeared by the intrathecal administration of methotrexate, cytosine arabinoside and prednisolone, but the visual disturbance improved only partially, and the pain in the cervical, shoulder and lumbar area disappeared completely only by systemic chemotherapy (aclarubicin with cytosine arabinoside). The orbital CT scan showed the thickening of the optic nerve, but the autopsy findings revealed the leukemic cell infiltration in the optic nerve, and the visual disturbance was ascribed to the RochonDevigneand's syndrome of the orbital apex by the leukemic cell infiltration. On the other band, diffuse infiltration of leukemic cells was marked on the cervical, brachial and lumbar plexus. In order to prolong survival and to relieve pain from the nenuopathy by leukemic cell infiltration, we recommend intrathecal route of the prophylactic chemotherapy concomitant with skull radiation even in the early stage of therapy for acute nonlymphocytic leukemia.
