A 45-year-old woman presented with sudden severe excruciating headache. Medical history disclosed intermittent fever and weight loss in the past 3 months. No focal neurological deficits were seen. CT scan disclosed diffuse subarachnoid hemorrhage. Cranial CT angiography showed no intracranial aneurysms (Figure). Laboratory evaluation disclosed thrombocytopenia, anemia and abnormalities of white blood cell. Bone marrow biopsy confirmed acute promyelocytic leukemia (APML).
Subarachnoid hemorrhage in acute promyelocytic leukemia. (A-C) Cranial CT disclosing diffuse subarachnoid hemorrhage. (D) No intracranial aneurysms disclosed by brain CT angiography. (E) Promyelocyte cell with Auer rods (black arrows).
Cerebrovascular disease is a frequent neurological complication in oncological patients, generally secondary to coagulopathies related to the neoplasm or drug-induced bleeding11. Rogers LR. Cerebrovascular complications in patients with cancer. Semin Neurol. 2010;30(3):311-9. doi:10.1055/s-0030-1255224. Brain hemorrhage is most common in acute leukemias, especially in APML, and sometimes represents the presenting syndrome22. Vásquez E, Lucaya J, Castellote A, Piqueras J, Sainz P, Olivé T, et al. Neuroimaging in pediatric leukemia and lymphoma: differential diagnosis. RadioGraphics 2002;22(6):1411-28. doi:10.1148/rg.226025029.
References
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1Rogers LR. Cerebrovascular complications in patients with cancer. Semin Neurol. 2010;30(3):311-9. doi:10.1055/s-0030-1255224
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2Vásquez E, Lucaya J, Castellote A, Piqueras J, Sainz P, Olivé T, et al. Neuroimaging in pediatric leukemia and lymphoma: differential diagnosis. RadioGraphics 2002;22(6):1411-28. doi:10.1148/rg.226025029
Publication Dates
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Publication in this collection
06 Oct 2015 -
Date of issue
Dec 2015
History
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Received
12 Apr 2015 -
Reviewed
03 June 2015 -
Accepted
23 June 2015
