To the Editor.—Meningeal leukemia should be suspected when patients with acute leukemia complain of headaches, vomiting, blurred vision, excessive weight gain, stiff neck, lethargy, convulsions, or even coma.1,2
We have treated a child with acute leukemia in whom central nervous system (CNS) involvement was manifested by a unique symptom, a pulsating occipital mass.
Report of a Case
Acute lymphoblastic leukemia was diagnosed in a boy 8 years of age. Induction therapy with vincristine sulfate and prednisone was followed by maintenance therapy with mercaptopurine. The CNS involvement was not treated.Twenty-two months after diagnosis, he began to complain of headache, and a palpable nontender mass was noted on the posterior aspect of the skull. During the next nine months, he had one episode of right-sided hemiplegia with spontaneous recovery. Headaches, vomiting, and progressive sensory neural hearing loss with visual weakness and blurring were noted.Because of these complications, the