Cerebellar coning and uncal herniation in childhood acute leukaemia
Sinniah, D.; Looi, L.M.; Ortega, J.A.; Siegel, S.E.; Landing, B.
Lancet 2(8300): 702-704
1982
ISSN/ISBN: 0140-6736 PMID: 6126636 Document Number: 195468
Cases (188) of childhood leukemia came to necropsy at the Children's Hospital of Los Angeles [California, USA] between 1965 and 1978. Necropsy records show that cerebellar coning and/or uncal herniation occurred in 5 of 47 cases with CNS leukemia and in only 1 of 141 without meningeal or cerebral infiltration. A review of the 168 cases of acute lymphocytic leukemia treated at the University Hospital, Kuala Lumpur [Malaysia], since 1968 revealed another instance of coning, which occurred in a patient with CNS leukemia. Of these 7 children with coning and/or uncal herniation, 4 did not have papilledema, and the diagnosis was made only at necropsy. Coning was recognized 48 h after lumbar puncture in 2 children. In the other 5 cases, there was no relation between coning and lumbar puncture. This life-threatening complication should be considered before patients with CNS leukemia are subjected to lumbar puncture.