Meningopatia leucémica em paciente com remissão hematológica tratado com sucesso pelo Amethopterin Intratecal

Ritter, Mário; Zukerman, Eliova; Reis, J. Baptista dos

doi:10.1590/S0004-282X1965000100005

Resumos

É apresentado um caso de meningopatia leucêmica com um quadro de hipertensão intracraniana, que surgiu 18 meses após a remissão clínica e hematológica de leucemia aguda. A terapêutica por via intratecal com o Amethopterin, na dose de 5 mg, repetida 6 vêzes e com intervalos de 5 a 7 dias, proporcionou melhora clínica imediata e normalização do LCR após dois meses de tratamento. O paciente continuou bem clinicamente e com o sangue e o LCR normais após 4 meses de observação. A experiência dêste caso e daqueles citados na literatura justificam que todos os pacientes leucêmicos sejam cuidadosamente observados a fim de se poder diagnosticar precocemente uma complicação neurológica, para que o tratamento adequado possa permitir maior sobrevida. O exame do LCR tem importância decisiva no diagnóstico desta complicação; ulteriormente, os exames seriados do LCR orientam a duração e a intensidade do tratamento. A padronização do tratamento das complicações neurológicas das leucemias constitui campo aberto às investigações.

The case of a 3-year old boy affected by acute leukemia and presenting a picture of meningeal involvement is discussed. The neurological ma- nifestations occurred after a period of 18 months of clinical and hematological remission. The symptoms were those of intracranial hypertension; presence of numerous leukemic cells in the cerebrospinal fluid and widening of cranial sutures were observed. A two months course of treatment with intrathecal injection of 5 mg Amethopterin each brought about an excellent neurological recovery that is lasting for more than 4 months. The injections were made firstly at a five day interval, which was increased at the end of the treatment. The experience of this case added to those of prior cases documented in the literature stresses the importance of the problem. It is suggested that every case of leukemia be thoroughly examined and if symptoms and signs of neurological involvement were found, cerebrospinal fluid examination must be performed. Thus acting it will be possible to diagnose nervous system involvement and start the treatment at earlier stages. In this way the patient may have a better and longer life. The graph clearly shows the importance of cerebrospinal fluid examinations to evaluate the results of the treatment.

REGISTRO DE CASOS

Meningopatia leucémica em paciente com remissão hematológica tratado com sucesso pelo Amethopterin Intratecal

Meningeal leukemia occurring in a patient with clinical and hematological remission successfully treated with intrathecal Amethopterin

Mário Ritter^I; Eliova Zukerman^II; J. Baptista dos Reis^II

^IAssistente do Departamento de Clínica Médica (Secção de Hematologia) da Escola Paulista de Medicina

^IIAssistentes do Departamento de Neurologia da Escola Paulista de Medicina

RESUMO

É apresentado um caso de meningopatia leucêmica com um quadro de hipertensão intracraniana, que surgiu 18 meses após a remissão clínica e hematológica de leucemia aguda. A terapêutica por via intratecal com o Amethopterin, na dose de 5 mg, repetida 6 vêzes e com intervalos de 5 a 7 dias, proporcionou melhora clínica imediata e normalização do LCR após dois meses de tratamento. O paciente continuou bem clinicamente e com o sangue e o LCR normais após 4 meses de observação. A experiência dêste caso e daqueles citados na literatura justificam que todos os pacientes leucêmicos sejam cuidadosamente observados a fim de se poder diagnosticar precocemente uma complicação neurológica, para que o tratamento adequado possa permitir maior sobrevida. O exame do LCR tem importância decisiva no diagnóstico desta complicação; ulteriormente, os exames seriados do LCR orientam a duração e a intensidade do tratamento. A padronização do tratamento das complicações neurológicas das leucemias constitui campo aberto às investigações.

SUMMARY

The case of a 3-year old boy affected by acute leukemia and presenting a picture of meningeal involvement is discussed. The neurological ma- nifestations occurred after a period of 18 months of clinical and hematological remission. The symptoms were those of intracranial hypertension; presence of numerous leukemic cells in the cerebrospinal fluid and widening of cranial sutures were observed. A two months course of treatment with intrathecal injection of 5 mg Amethopterin each brought about an excellent neurological recovery that is lasting for more than 4 months. The injections were made firstly at a five day interval, which was increased at the end of the treatment. The experience of this case added to those of prior cases documented in the literature stresses the importance of the problem. It is suggested that every case of leukemia be thoroughly examined and if symptoms and signs of neurological involvement were found, cerebrospinal fluid examination must be performed. Thus acting it will be possible to diagnose nervous system involvement and start the treatment at earlier stages. In this way the patient may have a better and longer life. The graph clearly shows the importance of cerebrospinal fluid examinations to evaluate the results of the treatment.

Texto completo disponível apenas em PDF.

Full text available only in PDF format.

Trabalho apresentado ao Departamento de Hematologia e Hemoterapia da Associação Paulista de Medicina em 8-9-1964.

Caixa Postal 5496 - São Paulo, SP - Brasil.

1. HYMAN, C. B.; BRUBAKER, C. A.; BORDA, C. E.; HAMMOND, D. & STURGEON, P. - Treatment of central nervous system leukemia in children. Proc. Am. A. Cancer Research 3:29, 1959.
2. LAURANCE, B. M. - Intracranial complications of leukemia treated with intrathecal Amethopterin. Arch. Dis. Childh., 36:107, 1961.
3. LEIDLER, F. & RUSSELL, W. O. - The brain in leukemia. Arch. Path., 40:14, 1945.
4. MURPHY, M. L. - Leukemia and lymphoma in children. Pediat. Clin. N. Amer., 6:611, 1959.
5. NORDLANDER, N. B. - Eosinophilic leukemia; infiltration of the gasserian ganglion. Acta Med. Scandinav., 139:146, 1951.
6. RAMOS Jr., J.; De BELLIS, N. & REIS, J. B. - Localização neurológica da leucemia aguda; estudo sôbre um caso e valor terapêutico do Amethopterin por via intra-tecal. II Simpósio de Quimioterapia Antineoplásica, Belo Horizonte, julho de 1963.
7. SANSONE, G. - Pathomorphosis of acute infantile leukaemia treated with modern therapeutic agents; "meningoleukaemia" and Frölich's obesity. Ann. Paediat., 183:33, 1954.
8. SCHWAB, R. S. & WEISS, S. - Neurologic aspects of leukemia. Am. J. Med. Sc., 189:766, 1935.
9. SHANBROM, E.; MILLER, S. & FAIRBANKS, V. F. - Intrathecal administration of Amethopterin in leukemic encephalopathy of young adults. New England J. Med., 265:169, 1961.
10. SHAW, R. K.; MOORE, E. W.; FREIREICH, E. J. & THOMAS, L. B. - Meningeal leukemia: a syndrome resulting from increased intracranial pressure in patients with acute leukemia. Neurology 10:823, 1960.
11. SULLIVAN, M. P. - Intracranial complications of leukemia in children. Pediatrics 20:757, 1957.
12. WELLS, C. E. & SILVER, R. T. - The neurologic manifestations of the acute leukemias: a clinical study. Ann. Intern. Med., 46:439, 1957.
13. WHITESIDE, J. A.; PHILIPS, F. S.; DARGEON, H. W. & BURCHENAL, J. H. - Intrathecal Amethopterin in neurological manifestations of leukemia. Arch. Int. Med., 101:279, 1958.
14. WILLIAMS, H. M.; DIAMOND, H. D.; CRAVER, L. F. & PARSONS, H. - Neurological Complications or Lymphoma and Leukemias. Charles C. Thomas, Springfield (Illinois), 1959.

Datas de Publicação

Publicação nesta coleção
15 Ago 2013
Data do Fascículo
Mar 1965

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. HYMAN, C. B.; BRUBAKER, C. A.; BORDA, C. E.; HAMMOND, D. & STURGEON, P. - Treatment of central nervous system leukemia in children. Proc. Am. A. Cancer Research 3:29, 1959.

[2] 2. LAURANCE, B. M. - Intracranial complications of leukemia treated with intrathecal Amethopterin. Arch. Dis. Childh., 36:107, 1961.

[3] 3. LEIDLER, F. & RUSSELL, W. O. - The brain in leukemia. Arch. Path., 40:14, 1945.

[4] 4. MURPHY, M. L. - Leukemia and lymphoma in children. Pediat. Clin. N. Amer., 6:611, 1959.

[5] 5. NORDLANDER, N. B. - Eosinophilic leukemia; infiltration of the gasserian ganglion. Acta Med. Scandinav., 139:146, 1951.

[6] 6. RAMOS Jr., J.; De BELLIS, N. & REIS, J. B. - Localização neurológica da leucemia aguda; estudo sôbre um caso e valor terapêutico do Amethopterin por via intra-tecal. II Simpósio de Quimioterapia Antineoplásica, Belo Horizonte, julho de 1963.

[7] 7. SANSONE, G. - Pathomorphosis of acute infantile leukaemia treated with modern therapeutic agents; "meningoleukaemia" and Frölich's obesity. Ann. Paediat., 183:33, 1954.

[8] 8. SCHWAB, R. S. & WEISS, S. - Neurologic aspects of leukemia. Am. J. Med. Sc., 189:766, 1935.

[9] 9. SHANBROM, E.; MILLER, S. & FAIRBANKS, V. F. - Intrathecal administration of Amethopterin in leukemic encephalopathy of young adults. New England J. Med., 265:169, 1961.

[10] 10. SHAW, R. K.; MOORE, E. W.; FREIREICH, E. J. & THOMAS, L. B. - Meningeal leukemia: a syndrome resulting from increased intracranial pressure in patients with acute leukemia. Neurology 10:823, 1960.

[11] 11. SULLIVAN, M. P. - Intracranial complications of leukemia in children. Pediatrics 20:757, 1957.

[12] 12. WELLS, C. E. & SILVER, R. T. - The neurologic manifestations of the acute leukemias: a clinical study. Ann. Intern. Med., 46:439, 1957.

[13] 13. WHITESIDE, J. A.; PHILIPS, F. S.; DARGEON, H. W. & BURCHENAL, J. H. - Intrathecal Amethopterin in neurological manifestations of leukemia. Arch. Int. Med., 101:279, 1958.

[14] 14. WILLIAMS, H. M.; DIAMOND, H. D.; CRAVER, L. F. & PARSONS, H. - Neurological Complications or Lymphoma and Leukemias. Charles C. Thomas, Springfield (Illinois), 1959.