Case Analysis

Mr. X, 33 years old was take care on Neurologic

Department of Mohammad Hoesin General
Hospital due to sudden right-side weakness.
+ 5 hours before admitted to hospital, patient
got a sudden right-side weakness while on
activity. During attack, vomit (-), seizure (-),
headache cant be assessed, patient cant
understood nor explained his thought by
speech, handwriting and gestures,
weakness of muscles on one side of the mouth
(-), loss of speech (-).
 Since 1 year ago, patient has
complained of worsening headache,
in the entire head, pain increases in
the morning and the night.
Gradually, the headache cant be
treated with medication. Pain cant
be decreased by given the pain
medication and disrupt his activity.
Diplopia cant be assessed.
 Histor of diseases:
Hipertension (-)
DM (-)
Asphyxia (-)
Hematologic malignancy (+) since 10
months ago, taking medication routinely
This was the first time that the
patient suffered for these complaints.
 From anamnesis, there were
neurological deficit findings:
Headache rise of ICP and
hydrocephalus
Lateralitation Hemiparesis, aphasia
(the lession on parenchyma caused by
leptomeningeal metastasis from
Chronic Myelisotic Leukemia)
 Laboratorium: CML Findings
Anemia
Leukocytosis
Thrombocytosis
BMP CML
CT Scan:
Ischemic cerebral infark on left occipital hemispheres.
MRI:
Shows: meningoencephalitis on left cerebral
hemispheres and enchancement on left
leptomeningioma
 Pharmacology:
Omeprazole
Neurodex
Tramadol
Dexamethasone
Hidroxy urea for CML
 Conclusion
Leptomeningeal malignancy is a serious
complication that cause morbidity and
mortality.
Leptomeningen Metastasis (LM) is an
invasion on leptomeningen or CSF
because of the hematologic malignancy.
Diagnosis can be enforced by
anamnesis, physical examination, and
additional examination.
 Characteristic of Leptomeningeal
Metastasis is multifocal involvement of
CNS (cranial nerves, cerebrum, and
medula spinalis).
Cerebrospinal fluid examination and MRI
are needed on Leptomeningeal Leukemia
to assess the metastasis.
The purposes of therapy are not only to
extend life but also to minimalize the
neurological deficits.
 Quick therapy may cure and prevent
the neurological deficit.
Radiotherapy, sistemic
chemotherapy and chemotherapy
intrathecal are the choices of the
therapy.