Life-Threatening Intracerebral Hemorrhage in Previously Undiagnosed Acute T-Cell Lymphoblastic Leukemia with Blast Crisis: A Nightmare in Neurosurgeon's Life?

Abstract

Spontaneous, nontraumatic intracerebral hemorrhage is a significant cause of morbidity and mortality throughout the world. Acute lymphoblastic leukemia is the most common cancer diagnosed in children. According to the literature, only 6 cases of acute lymphoblastic leukemia presenting as intracerebral hemorrhage have been reported. Five out of the 6 patients were managed conservatively; 3 out of these 6 patients survived with correction of coagulopathy. Surgical intervention was performed in only 1 of the previously reported cases in which the patient could not be salvaged. We report a case of life-threatening intracerebral hemorrhage in previously undiagnosed acute T-cell lymphoblastic leukemia with blast crisis, in which the patient was salvaged from the catastrophic complication after surgical intervention.

Intracerebral haemorrhage as an initial manifestation of T-cell acute lymphoblastic leukaemia in a paediatric patient

“…2 3 The first manifestation of ALL is usually non-specific, 3 and there have been only a few reports of intracerebral haemorrhage (ICH) as an initial presentation of acute leukaemia in adolescents. [4][5][6][7][8][9] To our knowledge, three out of six of those reports involved fatal ICH. Haemorrhage is the second most common cause of mortality in acute leukaemia, and associated risk factors of fatal ICH include leucocytosis, thrombocytopenia and prolonged prothrombin time.…”

“…While T-ALL is a heterogeneous disease with diverse clinical and molecular features, hyperleucocytosis and central nervous system (CNS) involvement are common components of its clinical profile 2 3. The first manifestation of ALL is usually non-specific,3 and there have been only a few reports of intracerebral haemorrhage (ICH) as an initial presentation of acute leukaemia in adolescents 4–9. To our knowledge, three out of six of those reports involved fatal ICH.…”

Intracranial Hemorrhage Associated With T-Cell Acute Lymphoblastic Leukemia With Hyperleukocytosis: A Case Report

“…Intracerebral hemorrhage is rarely seen in T-cell ALL, but the probability of mortality and morbidity is high when it occurs. 4,6 We hereby present this case to provoke consideration of optimal timing and dosage of treatment in children with hyperleukocytosis.…”