Diagnosis of acute lymphoblastic leukemia from intracerebral hemorrhage and blast crisis. A case report and review of the literature

被引:11
作者
Naunheim, Matthew R. [1 ,3 ]
Nahed, Brian V. [1 ,3 ]
Walcott, Brian P. [1 ,3 ]
Kahle, Kristopher T. [1 ,3 ]
Soupir, Chad P. [2 ,3 ]
Cahill, Daniel P. [1 ,3 ]
Borges, Lawrence F. [1 ,3 ]
机构
[1] Massachusetts Gen Hosp, Dept Neurosurg, Boston, MA 02114 USA
[2] Massachusetts Gen Hosp, Dept Hematopathol, Boston, MA 02114 USA
[3] Harvard Univ, Sch Med, Boston, MA 02114 USA
关键词
Acute leukemia; ALL; Blast crisis; Intracerebral hemorrhage; Leukocytosis; FATAL INTRACRANIAL HEMORRHAGE; CEREBRAL-HEMORRHAGE; ASSOCIATION; MORTALITY; SURGERY; STROKE; MANAGEMENT; HEMATOMA; GROWTH;
D O I
10.1016/j.clineuro.2010.04.001
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Intracerebral hemorrhage (ICH) contributes significantly to the morbidity and mortality of patients suffering from acute leukemia. While ICH is often identified in autopsy studies of leukemic patients, it is rare for ICH to be the presenting sign that ultimately leads to the diagnosis of leukemia. We report a patient with previously undiagnosed acute precursor B-cell lymphoblastic leukemia (ALL) who presented with diffuse encephalopathy due to ICH in the setting of an acute blast crisis. The diagnosis of ALL was initially suspected, because of the hyperleukocytosis observed on presentation, then confirmed with a bone marrow biopsy and flow cytometry study of the peripheral blood. Furthermore, detection of the BCR/ABL Philadelphia translocation t(9:22)(q34:q11) in this leukemic patient by fluorescent in situ hybridization permitted targeted therapy of the blast crisis with imatinib (Gleevec). Understanding the underlying etiology of ICH is pivotal in its management. This case demonstrates that the presence of hyperleukocytosis in a patient with intracerebral hemorrhage should raise clinical suspicion for acute leukemia as the cause of the ICH. (C) 2010 Elsevier B.V. All rights reserved.
引用
收藏
页码:575 / 577
页数:3
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