Risk score model for fatal intracranial hemorrhage in acute leukemia

Kim, Ho; Jh, Lee; Sj, Choi; Seol, Miee; Ys, Lee; Wk, Kim; Js, Lee; Kh, Lee

doi:10.1038/sj.leu.2404148

Cited by 70 publications

(79 citation statements)

References 43 publications

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“…The possible risk factors of ICH caused by leukemia include thrombocytopenia, platelet dysfunction, disseminated intravascular coagulation (DIC), coagulation factor deficiency, hyperleukocytosis, vessel wall abnormalities, hypertension and sepsis [2,4]. Our patient had thrombocytopenia all the time.…”

Section: Discussionmentioning

confidence: 99%

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Subdural hemorrhages in acute lymphoblastic leukemia: case report and literature review

et al. 2016

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Background: Acute lymphoblastic leukemia is a rare hematological malignancy. Pure subdural hemorrhages in a patient with acute lymphoblastic leukemia patient are extremely rare. Case presentation: This case presented acute spontaneous subdural hemorrhage without head trauma at first, and acute lymphoblastic leukemia was diagnosed later. The second time, the patient was admitted with multiple pure subdural hemorrhages in different locations and periods with a history of slight head trauma. Conclusions: Pure subdural hemorrhages can occur in a patient with acute lymphoblastic leukemia. More care would be needed for pure subdural hemorrhages without obvious head trauma, and patients with hematological malignancies should be protected from even mild head trauma.

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Section: Discussionmentioning

confidence: 99%

“…Leukemia, especially acute types, can lead to intracranial hemorrhage (ICH) with high morbidity and mortality [1,2]. Chen CY et al reported that ICH occurred in 2.8 % adult patients with hematological malignancies [3].…”

Section: Introductionmentioning

confidence: 99%

Subdural hemorrhages in acute lymphoblastic leukemia: case report and literature review

et al. 2016

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“…All three of these patients developed a severe neurologic syndrome that rapidly evolved into coma and death. Kim et al reported 41 fatal intracranial hemorrhages among 792 acute leukemia patients (9). The most common type was acute promyelocytic leukemia (44%).…”

Section: Atil S Et Al: Fatal Intracranial Hemorrhage As the Initial mentioning

confidence: 99%

Fatal intracranial hemorrhage as the initial presentation of acute lymphocytic leukemia: case report

Patil¹,

Nourbakhsh²,

Thakur³

et al. 2012

Turkish Neurosurgery

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Hemorrhagic complications of acute leukemia are well described and are a common cause of mortality in these patients. However, to our knowledge, fatal intracerebral hemorrhage (ICH) as an initial presentation of acute lymphocytic leukemia (ALL) has only been reported once. We report a case of previously undiagnosed ALL presenting with ICH. Our patient is a 17-year old male who was found unresponsive several hours after complaining of headache. Initial emergency room evaluation found the patient to have anisocoria with a fixed and dilated right pupil and demonstrated evidence of decorticate posturing. Imaging revealed a large right-sided intraparenchymal hemorrhage, intraventricular hemorrhage, midline shift, and uncal herniation. Laboratory evaluation showed marked leukocytosis with blastic predominance and evidence of disseminated intravascular coagulopathy. Emergent surgical intervention was performed. However, despite evacuation of the hematoma, the patient eventually progressed to clinical brain death. Usually, ICH is seen in ALL patients after the diagnosis has been made. We report a unique case of fatal intracranial hemorrhage as the initial presentation of ALL and discuss the possible management dilemmas to treat such entities. ALL should be kept in the broad differential diagnosis of spontaneous ICH, especially in a young patient with evidence of severe coagulopathy.KeywOrds: Acute lymphocytic leukemia, Disseminated intravascular coagulation, Subarachnoid hemorrhage, Intracerebral hemorrhage ÖZ Akut löseminin hemorajik komplikasyonları iyice tanımlanmıştır ve bu hastalarda mortalitenin sık görülen bir nedenidir. Ancak bildiğimiz kadarıyla akut lenfositik löseminin (ALL) başlangıç bulgusu olarak ölümcül intraserebral kanama sadece bir kez bildirilmiştir. İntraserebral kanama ile gelen ve önceden tanı konmamış bir ALL tanısı sunuyoruz. Hastamız 17 yaşında bir erkekti ve baş ağrısından yakındıktan birkaç saat sonra tepki göstermez bir şekilde bulundu. Acil servisteki başlangıç değerlendirmesi hastada anizokori ve sabit ve dilate sağ pupil saptadı ve dekortike postür bulguları mevcuttu. Görüntüleme büyük bir sağ taraflı intraparenkimal kanama, intraventriküler kanama, orta hatta kayma ve unkal herniasyon gösterdi. Laboratuvar değerlendirmesi blast predominansı ile belirgin lökositoz ve dissemine intravasküler koagülopati bulguları gösterdi. Hemen cerrahi girişim yapıldı. Ancak hematom boşaltılmasına rağmen hasta hızla klinik beyin ölümüne ilerledi. İntraserebral kanama, ALL hastalarında genellikle tanı konduktan sonra saptanır. ALL'nin ilk bulgusu olarak ölümcül intrakraniyal kanama görülen benzersiz bir vaka bildiriyor ve bu tür vakaları tedavi etmekte olası ikilemleri tartışıyoruz. ALL özellikle şiddetli koagülopati bulgusu olan genç hastalarda spontan intraserebral kanamanın ayırıcı tanısında dikkate alınmalıdır.

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“…Brainstem, epidural and subarachnoid hemorrhage are particularly dangerous (Chen et al, 2009). In a risk score model for fatal intracranial hemorrhage, female gender, thrombocytopenia, prolonged prothrombin time, hyperleukocytosis (particularly in presence of symptoms of pulmonary leukostasis), and acute promyelocytic leukemia (APL), were significantly associated with the occurrence of this complication (Kim et al, 2006). Thrombotic events, particularly sino-venous thrombosis, are more frequent in ALL.…”

Section: Cerebrovascular Accidentsmentioning

confidence: 99%