Epidural spinal cord compression in acute myelogenous leukemia

Meningeal infiltration is the most common neurological complication in acute leukemias. In acute lymphocytic leukemia (ALL), its incidence has reached 50% to 70% before the use of CNS-prophylaxis. Even after CNS-prophylaxis meningeal leukemia is observed in 5% to 10% of patients with ALL. In AML, where CNS-prophylaxis is not a standard procedure, and during the blastic phase of chronic myelogenic leukemias (CML), meningeal infiltration is more frequent. On the contrary, symptomatic epidural metastases are very rare in patients with leukemia. Leukemias are not specifically mentioned in large series reporting primary sites of epidural space metastases. Moreover, to our knowledge, this complication has not been found in systematic clinical surveys of patients with acute leukemia. Rare cases of spinal cord compression by epidural proliferation of leukemia cells during the blastic phase of CML are found in the literature. Chloromas are another very large cause of spinal compression in patients with chronic myelogenous leukemia. In the described patient, leukemic blasts were found only in the epidural space even after an elaborate pathological examination. Because we were not aware that the epidural space could be the only site for AML recurrence, the efforts to establish the diagnosis were insufficient when early and transitory neurological signs appeared and therefore the subsequent treatment, which started with laminectomy, was delayed.SCOPUS: ar.j