Sphincter Disturbance as the Initial Presentation of Acute Lymphoblastic Leukemia：A Case Report

Acute leukemia is the most common malignancy involving the central nervous system (CNS) among childhood. Neurological manifestations of leukemia frequently occur during the course of acute leukemia. However, it is rarely an isolated feature as the initial presentation of leukemia. The spinal cord and spinal roots are less frequently involved than other CNS regions. It is very rare to have neurologic involvement of conus medullaris as an initial presentation of acute lymphoblastic leukemia (ALL). This case was a 16 year-old boy who suffered from sever back pain and disturbance of sphincter function before the diagnosis of ALL. The diagnosis of acute lymphoblastic leukemia (L3, Burkitt’s type) with leptomeningeal involvement was confirmed based on the bone marrow and cerebral spinal fluid examinations. Now that management of leukemia is possible and even is successful with chemotherapy and radiotherapy, it is more important to recognize and alleviate any neurologic morbidity of these patients. We presented this case with an attempt to cover the pathogenesis, differential diagnosis, treatment of ALL involving spinal cord and to call the attention to such case.