Dural metastases in chronic myeloid leukemia presenting as subdural hematoma”

Moon

et al. 2015

Korean J Neurotrauma

IntroductionA chronic subdural hematoma (CSDH) is a well-known disease of intracranial hemorrhage in old people. The burr hole trephination is the usual treatment of CSDH with a good outcome and prognosis.Despite the simple treatment of CSDH, the recurrence rate of CSDH is not low. The recurrence rate of CSDH ranged between 10% and 33% in previous studies.26) Many studies have been reported on factors associated with the recurrence of CSDH; however, the results were inconsistent. The purpose of this study was to identify risk factors for the recurrence of CSDH. We hypothesized that some factors including age, sex, underlying disease, radiological images and surgical procedures affect the recurrence of CSDH. Series of 368 surgical patients were retrospectively evaluated and analyzed to support this hypothesis. Materials and Methods Patient selectionWe retrospectively evaluated 368 patients who underwent a surgery with CSDH. The patients visited the department of neurosurgery at Seoul National University Bundang Hospital between January 1993 and December 2013. Objective: Chronic subdural hematoma (CSDH) is a common form of extra axial hemorrhage in the elderly. A surgical procedures such as a burr hole trephination are used for the CSDH treatment. The recurrence rate of CSDH is reported to range from 2.3 to 33%. In the current study, we focused on the determination of risk factors associated with the recurrence of CSDH. Methods: We retrospectively reviewed 368 consecutive patients with CSDH treated by burr hole trephination. Univariate and multivariate analysis were performed to describe the relationships between clinical and radiological factors as well as the recurrence of CSDH. Results: Totally 31 (8.4%) patients experienced a recurrence of CSDH in our study. The male group (10.2%) had a higher recurrence rate than the female group (3.1%). Also patients with malignant neoplasm history showed a high recurrence rate (17.9%). The recurrence rate of single layer CSDH (13.1%) and isodensity CSDH (11.7%) was highly significant also. Conclusion: Sex, history of malignant neoplasm and the hematoma type on computed tomography were factors related with the recurrence of CSDH in our study. These findings may be supportive in the identification of patients at risk for a recurrence of CSDH. CLINICAL ARTICLE Korean

Section: Discussionmentioning

confidence: 99%

Risk Factor Analysis for the Recurrence of Chronic Subdural Hematoma: A Review of 368 Consecutive Surgical Cases

Moon

et al. 2015

Korean J Neurotrauma

“…Symptoms of bleeding usually indicate disease progression in the case of the progression of qualitative or quantitative thrombocytic abnormalities. [1,10] In a few cases, bleeding in CML in CP after diagnosis can be caused by metastasis of leukemic cells, [7] interferon-γ (IFN-γ) induced inhibitor of clotting factors [16] or tyrosine kinase inhibitor (TKI) agents triggered platelet dysfunction. [17]…”

Section: Discussionmentioning

confidence: 99%

“…[1] The occurrence of bleeding in CML usually suggests disease progression, which is caused by abnormal quantity or quality of thrombocyte. [1] Though anecdotal, the reported CML in CP initially presenting with hematoma includes intramuscular hematoma, [2,3] mediastinal hematoma, and hemothroax, [4] spinal epidural hematoma, [5] cerebellar hemorrhage, [6] subdural hematoma, [7–9] and deep soft-tissue hematomas. [10] Except for blast cell infiltration, [7] acquired von Willebrand factor (VWF) deficiency [8] or speculated platelet dysfunction [10] associated with hyper-thrombocytosis, most reported cases show almost normal results of clotting screening tests, including PT, activated partial thromboplastin time (APTT), thromboplastin time (TT), and platelet counting.…”

Section: Introductionmentioning

confidence: 99%

Bleeding with negative coagulation screening test as initial presentation of chronic myelogenous leukemia managed by fresh frozen plasma

Wang

Wang²,

Xi³

et al. 2019

Medicine

Introduction:Chronic myelogenous leukemia (CML), a clonal disorder of pluripotent stem cell, rarely presents with bleeding in chronic phase due to the function preservation of the platelets. Factor (F) XIII deficiency, an extremely rare hemorrhagic disease, can cause fatal bleeding, which has been previously described in autoimmune disorders and leukemias.Patient concerns:A 38-year-old woman with a 20-day history of spontaneous subcutaneous hemorrhage visited our hospital, who presented with intracranial hemorrhage, hematuria, and delayed hematoma after a bone marrow puncture. Initial management included cytogenetics analysis, molecular analysis, and coagulation evaluation.Diagnosis:Bone marrow puncture, cytogenetics, and molecular analysis indicated the diagnosis of CML. With the normal results of clotting screening tests and platelet counting, as well as the relief of bleeding after infusion of fresh frozen plasma (FFP), acquired rare bleeding disorder probably associated with factor XIII (FXIII) deficiency.Interventions:Management with anti-hyperleukocytosis and chemotherapy, hydration, alkalization, diuresis, uric acid-lowering, molecular targeted drugs, and freshly frozen plasma transfusion therapy resolved the bleeding diathesis.Outcomes:The patient survived from the initial bleeding, however, she died. Twenty six months later due to the progression of CML.Lessons:CML can initially present as unusual bleeding, possibly related to FXIII defect. It is essential to screen coagulopathy including FXIII activity and to supplement plasma for CML patients who present initially as bleeding, which cannot be deciphered by the routine clotting screening test.

“…In the latter cases, contrary to the findings of the present case, immature blasts were the predominant cells in the patients' cerebrospinal fluid. Dural metastasis of CML is rare, but it has been reported ( 14 , 15 ), and leukemic infiltration of the dura mater is considered to be a cause of chronic subdural hematoma ( 15 ). Hypertrophic panmeningitis is a rare disorder characterized by fibrosis and thickening of the dura matter, and it can occur idiopathically or secondary to an infection, autoimmune disorder, or malignancy, including CML ( 16 ).…”

Section: Discussionmentioning

confidence: 99%

A Rare Monocytic Crisis of Chronic Myelogenous Leukemia Presenting with Unusual Extramedullary Manifestations and an Atypical (14;22)(q24;q11.2) Translocation in the Bone Marrow

et al. 2017

A 48-year-old man was admitted due to marked leukocytosis. Bone marrow examinations resulted in a diagnosis of Philadelphia (Ph) chromosome-positive chronic myeloid leukemia. One month later, massive muscle and bone invasion by leukemic cells was detected. After induction chemotherapy, he complained of a headache and visual loss, which was caused by a leukemic infiltration in the central nervous system. After temporary remission in response to chemotherapy, the disease relapsed in the form of an intracranial tumor. The unusual t(14;22)(q24;q11.2) translocation of the Ph-chromosome and the significant increase in monocytes observed might have contributed to the unique and aggressive clinical course.