慢性淋巴细胞白血病伴中枢神经系统浸润1例并文献复习

    目的   探讨慢性淋巴细胞白血病（chronic lymphocytic leukemia，CLL）伴中枢神经系统（central nervous system，CNS）浸润的发病率、诊治方法及预后。    方法   报道1例以头晕、复视、肢体无力为首发表现的CLL患者诊治经过并结合文献复习。    结果   尸解研究显示CLL浸润CNS的发生率为8%~71%，而患者生前出现有症状CNS浸润的发生率较低约1%，发生原因与临床分期、年龄、性别及疾病变异无明确相关性，临床表现不特异，诊断主要依靠脑脊液细胞形态学结合流式细胞分析，鞘内化疗及放疗可使多数患者CNS症状及脑脊液改善，未治疗的患者均迅速恶化死亡。    结论   CLL有症状的CNS浸润较少见，一旦发生预后差，及时诊断和积极治疗是获得长期缓解的关键。

The neurologic com- plications of B-cell chronic lymphocytic leukemia

    Objective   To explore the incidence, diagnosis, treatment, and prognosis of central nervous system (CNS) infiltration in chronic lymphocytic leukemia (CLL).    Methods   One case with symptomatic CNS involvement reported dizziness, diplopia, and general fatigue as initial manifestations of CLL, as shown in a literature review.    Results   Autopsy studies revealed that leukemic invasion of CNS was found in 8% to 71% of CLL patients, whereas incidence of leukemic infiltration in symptomatic CNS was approximately 1%. The complication did not correlate with any evident risk factors, and symptoms in patients with leukemic CNS infiltration were heterogeneous and non-specific. Diagnosis of the disease depends on cerebrospinal fluid (CSF) cytology and flow cytometry. In most of similar cases, neurologic improvement is achieved by either intrathecal chemotherapy or radiation therapy. Failure to treat leukemic CNS infiltration leads to rapid deterioration and death.    Conclusion   Leukemic involvement of the CNS is very rare in CLL cases and indicates poor prognosis. Prompt diagnosis and aggressive treatment are crucial for long-term remission and complete resolution of neurological symptoms.