Sanjeev Kumar Verma, Mukesh Kumar Mishra, Rashmi Kumar, Archana Kumar, Nivedita Nimesh
BACKGROUND Neurological complications occur frequently in patients with cancer in all age groups. Few of these neurological complications are related to systemic effects of malignancy, and rest are related to treatment, but all of them contribute to disease course in terms of morbidity and mortality. The objectives of the study are to evaluate the prevalence of neurological manifestations and complications among the children with haematological malignancies and also to look for the outcome of such manifestation. MATERIALS AND METHODS This retrospective observational study was done at the Department of Paediatrics, King George Medical University (KGMU), Lucknow, India. All available records of children admitted till 2015 (20 years) with haematological malignancy in the department of Paediatrics, KGMU were searched. Those with any form of neurological manifestations or complications were included in the study and tried to look for the cause of the neurological issues. RESULTS 870 children with all types of haematological malignancies were found in dept. of Paediatrics, KGMU. Among all haematological malignancies, major contributors were Acute Lymphoblastic Leukaemia (ALL) 52.9%, Acute Myeloid Leukaemia (AML) 16.6% and Hodgkin Lymphoma 9.8%. About 82 (9.4%) Paediatric haemato-oncology patients had neurological manifestations or complications, among these 24.4% had intra cranial bleed, 9.8% with CNS relapse, 8.5% meningitis/ meningo-encephalitis, 7.5% with primary CNS involvement, 4.9% of cerebral atrophy and peripheral neuropathy, wherein 23.3% of the cases, diagnosis could not be established. Seizures, headache, altered sensorium/encephalopathy, cranial nerve1 palsies and focal deficits were the common presentations. CNS involvement at presentation, posterior reversible encephalopathy syndrome (PRES), spinal metastasis, sinus thrombosis, hydrocephalus, gliosis and intra cranial bleed were associated with adverse outcome. Overall 73.2% of children with neurological manifestations expired. CONCLUSION Paediatric haematological malignancies with neurological manifestations have wide spectrum of complications and aetiologies. Most of these complications lead to either long term morbidity or poor outcome.
