intracerebral leukocytostasis (Ball's disease)

A potentially fatal complication of acute leukemia, especially acute myelogenous leukemia, with WBC > 100,000/mm3. Etiology: 1) ACUTE leukemia, especially acute myelogenous leukemia (AML) 2) NOT a feature of high WBC counts associated with: a) chronic lymphocytic leukemia (CLL) b) chronic myelogenous leukemia (CML) Pathology: 1) increased blood viscosity with slowing of blood flow through the cerebral microvasculature when WBC > 100,000/mm3 2) primitive leukemic cells are capable of invasion through the endothelium, resulting in hemorrhage into the brain Clinical manifestations: 1) dizziness 2) visual disturbances 3) ataxia 4) stupor 5) coma Laboratory: - complete blood count (CBC) - white blood cell count (WBC) > 100,000/mm3 Management: 1) whole brain irradiation (600 cGy) 2) chemotherapy

References

Harrison's Principles of Internal Medicine, 14th ed. Fauci et al (eds), McGraw-Hill Inc. NY, 1998, pg 2503