With the advent of modern chemotherapy and subsequent alteration of the natural course of acute lymphocytic leukemia over the last decade, central nervous system (CNS) leukemia has emerged as a significant therapeutic problem.1
We have recently treated a patient with acute lymphocytic leukemia who had tremor, ataxia, and transient hemiparesis without classic signs of meningeal irritation. A diagnosis of multifocal leukoencephalopathy was entertained, but lumbar puncture revealed the true nature of the disease to be leukemic involvement of the CNS. A complete response to intrathecal methotrexate was obtained.
Report of a Case
A 4-year-old white boy was examined, and acute lymphocytic leukemia was diagnosed in June of 1966. He had obtained his fourth complete remission on vincristine sulfate, prednisone, and daunomycin in August 1968 and was being maintained on once-monthly doses of these drugs. Two weeks prior to admission in association with an upper respiratory infection, the parents