Department of Mohammad Hoesin General Hospital due to sudden right-side weakness. + 5 hours before admitted to hospital, patient got a sudden right-side weakness while on activity. During attack, vomit (-), seizure (-), headache cant be assessed, patient cant understood nor explained his thought by speech, handwriting and gestures, weakness of muscles on one side of the mouth (-), loss of speech (-). Since 1 year ago, patient has complained of worsening headache, in the entire head, pain increases in the morning and the night. Gradually, the headache cant be treated with medication. Pain cant be decreased by given the pain medication and disrupt his activity. Diplopia cant be assessed. Histor of diseases: Hipertension (-) DM (-) Asphyxia (-) Hematologic malignancy (+) since 10 months ago, taking medication routinely This was the first time that the patient suffered for these complaints. From anamnesis, there were neurological deficit findings: Headache rise of ICP and hydrocephalus Lateralitation Hemiparesis, aphasia (the lession on parenchyma caused by leptomeningeal metastasis from Chronic Myelisotic Leukemia) Laboratorium: CML Findings Anemia Leukocytosis Thrombocytosis BMP CML CT Scan: Ischemic cerebral infark on left occipital hemispheres. MRI: Shows: meningoencephalitis on left cerebral hemispheres and enchancement on left leptomeningioma Pharmacology: Omeprazole Neurodex Tramadol Dexamethasone Hidroxy urea for CML Conclusion Leptomeningeal malignancy is a serious complication that cause morbidity and mortality. Leptomeningen Metastasis (LM) is an invasion on leptomeningen or CSF because of the hematologic malignancy. Diagnosis can be enforced by anamnesis, physical examination, and additional examination. Characteristic of Leptomeningeal Metastasis is multifocal involvement of CNS (cranial nerves, cerebrum, and medula spinalis). Cerebrospinal fluid examination and MRI are needed on Leptomeningeal Leukemia to assess the metastasis. The purposes of therapy are not only to extend life but also to minimalize the neurological deficits. Quick therapy may cure and prevent the neurological deficit. Radiotherapy, sistemic chemotherapy and chemotherapy intrathecal are the choices of the therapy.