Non-aneurysmal non-traumatic subarachnoid hemorrhage: think also in acute promyelocytic leukemia

Hemorragia subaracnóidea não-traumática não-aneurismática: pense também em leucemia aguda promielocítica

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).

Figure
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 bleeding¹. Brain hemorrhage is most common in acute leukemias, especially in APML, and sometimes represents the presenting syndrome².

References

• ¹ Rogers LR. Cerebrovascular complications in patients with cancer. Semin Neurol. 2010;30(3):311-9. doi:10.1055/s-0030-1255224
• ² 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

Publication Dates

• Publication in this collection
  06 Oct 2015
• Date of issue
  Dec 2015

History

• Received
  12 Apr 2015
• Reviewed
  03 June 2015
• Accepted
  23 June 2015