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Chronic Myeloid Leukemia CML presenting with isolated central nervous System

Chronic Myeloid Leukemia CML presenting with isolated central nervous system CNS blast crisis is uncommon A 22 years male with chronic phase CML was in hematological and cytogenetic remission till July 2016 had acute onset headache and vomiting with meningeal signs and was admitted elsewhere investigated by brain imaging and CSF analysis and suspected to have tubercular meningitis for which steroids and anti tubercular medications were started Patient continued to be deteriorated and VP shunt surgery was done for hydrocephalus by neurosurgeon After 2 months of the illness he was admitted with persistent headache and vomiting recurrent seizures altered sensorium and on examination had meningeal signs CSF showed lymphocytic pleocytosis with positive cytospin for myeloid blasts on Myeloperoxidase MPO staining He was still in hematological remission A diagnosis of isolated CNS blast crisis was made and he was transferred to hemato oncology department where chemotherapy was started and he had improvement

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