[Fatal cerebral apoplexy as the first manifestation of immature infantile leukemia (author's transl)].

Among 93 clinical cases of mature and immature leukemia among children in the last 10 years only 3 showed massive cerebral hemorrhage as the first manifestation. The children--aged 5 3/12 yr., m., 2 1/12 yr., f., and 10 3/12 yr., m. died within 40, 48 and 7 h, respectively. Characteristically, an extreme hyperleukocytosis of immature cells with 8999000, 585000, and 360000 cells/mm3, respectively was found. Morphologically the quantitatively varying occurrence of blasts in veins and arteries, basically of hemodynamic origin, is notable, while locally pronounced variations in the venous involvement apparently are strongly dependent upon endovasal growth periods of the blasts. The blasts penetrated extravasal areas not only via passive but also via active migration. The mainly round to oval shape of the perivascular infiltrates of blasts is determined especially by the Virchow-Robins' spaces. The abscence of growth disrupting hemodynamics and texture structures in the unhindered areas of the cerebral ventricle system and retinal detachement favors the formation of leukemic nodules. Neurological symptoms accompanying a high blast count point to a diagnosis of intracerebral hemorrhage.