Cerebral spinal fluid has nuclear cells so high, what's going on?

Central nervous system leukemia (CNSL), referred to as "brain white", is a type of myeloid leukemia caused by the infection of leukemia cells into the cobweb membrane or its adjacent nerve tissue, is a common complication of leukemia, is one of the main obstacles to the long-term survival of patients with acute leukemiaCNSL mainly occurs in cobweb synocoscins, epidurals, brain essence, veins and brain nervesCentral nervous system leukemia is common in acute lymphoblastic leukemiaAcute myeloid leukemia is common in M4 and M5Children's ALL concurrent CNSL was much higher than adult ALLClinically, meninges are often used for meninges stimulation symptoms and elevated intracranial pressurecerebrospinal fluid cytological examination is the study of the morphological analysis of cells in cerebrospinal fluid, when the central nervous system lesions are, the number of cells in the cerebrospinal fluid, the morphology will also change, therefore, through the examination of cerebrospinal fluid, we can understand these changes, to achieve the diagnosis, treatment and prognosis of central nervous system diseasescase waspatient, male, 17 years oldthe main complaint: about 10 days ago, there was no clear cause of the lower back and double lower limb numbness paincurrent medical history: in the local health hospital live hemolytic silt treatment, symptoms do not ease, transferred to the city hospital line MRI shows lumbar 1-4 occupancy lesions, the above symptoms persist, and later in my hospital, to "lumbar vertebrae occupied" for the diagnosis income of our hospitalpast history: 6 years ago, the diagnosis of ALL, in Zheng Dayi hospital after treatment after full remission and dischargedadmission- to the hospital:blood routine: W: 4.66 x 10?9/L, R: 4.45 x 10?12/LHb: 135.0g/L, PLT: 183 x 10?9/L
cerebrospinal fluid biochemical : Total protein: 308.5mg/dL, cerebrospinal sugar: 0.3mmol/L, chloride: 112.3mmol/L, lactic acid dehydrogenase: 922.6U/L, adenosine deglycee: 314.7U/L MRI: The cartilage membrane splintered and strengthened, altered in the T12-L5 flat vertebral tube; meninges: neck resistance to three horizontal fingers, kerning positive, Brudzinski positive case analysis in order to further determine the cause of pain in the lower back and double lower limbs of patients, clinical test cerebrospinal fluid routine, cerebrospinal fluid appearance pale yellow, slightly hunky Under the microscope, there was a significant increase in the number of nuclear cells Cytological smearS Reed staining, as follows 1-4: mirror can be seen a large number of nuclear cells, mainly abnormal lymphocytes, such cells scattered in or into clusters, cell medium size, cell pulp less, dyed light blue; to carry out a bone-through parallel bone marrow cytological examination, as shown in Figure 5-8: bone marrow smear analysis: a roughly normal bone marrow image, no primary young lymphocytes summary the national working meeting on leukemia prevention and treatment in Nanning, Guangxi, in October 1978, the diagnosis criteria for central nervous system leukemia (CNSL) are as follows: (1) have central nervous system symptoms and signs (especially symptoms and signs of increased intracranial pressure) (2) there is a change in cerebrospinal fluid: (1) pressure increase (-0.02kPa or 200mm water column), or greater than 60 drops/min (2) white blood cell count s.01 x 109/L (3) smears to see leukemia cells (4) protein s 450mg/L, or Pandey tested positive (3) to exclude similar changes in the central nervous system or cerebrospinal fluid caused by other causes Note: A In accordance with (3) and (2) any one of the suspected central nervous system leukemia; B Asymptomatic, but with changes in cerebrospinal fluid, CNSL can be diagnosed However, if only a single cerebrospinal fluid pressure increases, the diagnosis of CNSL is not certain If cerebrospinal fluid pressure continues to increase, and the pressure of anti-CNSL treatment decreases, the normal person can also diagnose CNSL, and should be dynamically observed one of the bases for clinical diagnosis of central nervous system leukemia patients is cerebrospinal fluid cytological examination, such as leukaemia cells in the smears are in line with the morphological index of CNSL diagnosis, this method is an important basis for early diagnosis of CNSL patients for the above cases, cerebrospinal fluid has nuclear cells as high as 12739 x 10 x 6/L, Rui's stainfound found that nuclear cells are mainly abnormal lymphocytes, and the patient 6 years ago has been diagnosed WITH ALL, then consider acute lymphoblastic leukemia recurrence and central nervous system leukemia, so the lower back and lower limb pain, meninges stimulate positive Clinical detection of micro-residual lesions, beta-microglobulins in cerebrospinal fluid, and methods such as cerebrospinal fluid flow cytokine can be recommended to improve diagnostic accuracy CNSL disease has hidden, early clinical manifestations are atypical, even no positive symptoms and signs, the most important diagnosis is based on the detection of leukemia cells in cerebrospinal fluid However, in clinical lycation did not show symptoms of central nervous system injury, or symptoms but not obvious, its cerebrospinal fluid count is normal, encountered this situation, if not to carry out cytological examination is easy to misdiagnosis or missed diagnosis, so the cerebrospinal fluid cytological examination has irreplaceable qualitative diagnostic value Author: Zhang Xianbo Zhang Longxian Unit: Second People's Hospital, Nanyang City, Henan Province Source: