Section 1 - Direct leukemic involvement of the Central Nervous System

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Meningeal disease: Mimics of leukemic meningeal disease

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Case 4 

A 39 year old male with ALL
This patient was known to have painful, difficult lumbar punctures, often contaminated with blood. He was also s/p multiple doses of intrathecal methotrexate. When he presented with lower thoracic and leg pain, an MR with contrast demonstrated diffuse linear and slightly nodular subarachnoid enhancement (arrows). However, CSF cytology 6 6 were negative for blasts. This is presumed to represent chemical arachnoiditis scondary to chemotherapy and multiple traumatic taps.

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