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Case Reports
. 2022 Mar 11:13:89.
doi: 10.25259/SNI_958_2021. eCollection 2022.

Cerebral sinus thrombosis as an initial symptom of acute promyelocytic leukemia: Case report and literature review

Laura Salgado-Lopez  1 , Amanda Custozzo  2 , Nataly Raviv  2 , Tamer Abdelhak  3 , Maria Peris-Celda  4
Affiliations
Case Reports

Cerebral sinus thrombosis as an initial symptom of acute promyelocytic leukemia: Case report and literature review

Laura Salgado-Lopez et al. Surg Neurol Int. .

Abstract

Background: Cerebral sinus thrombosis as presentation of acute promyelocytic leukemia (AMPL) is exceptional, with only three cases registered in the literature.

Case description: A 24-year-old female patient was transferred to our center after a car accident. The patient had a witnessed generalized seizure while driving. Computerized tomography (CT) demonstrated a temporal intraparenchymal hemorrhage and CT venogram diagnosed a cerebral sinus thrombosis on the left transverse and sigmoid sinus. The patient underwent surgical evacuation of the hematoma and was treated with anticoagulation 48 h after surgery. Pancytopenia alerted of a possible hematological disorder. The patient was subsequently diagnosed with AMPL and treated with arsenic trioxide. The patient had a complete neurological recovery with no postoperative complications.

Conclusion: The management of cerebral sinus thrombosis in patients with AMPL remains controversial. The previous reported cases of cerebral sinus thrombosis preceding the diagnosis of AMPL are reviewed and treatment of cerebral sinus thrombosis with anticoagulation in the setting of intraparenchymal hemorrhage and bleeding disorders is also discussed.

Keywords: Acute promyelocytic leukemia; Cerebral sinus thrombosis; Intraparenchymal hemorrhage; Seizure.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1:
Figure 1:
Case illustration. (a) Preoperative CT scan of the head performed on arrival to our center demonstrating a left intraparenchymal hemorrhage of 47 × 31 × 60 mm, with mass effect on adjacent brain structures and a midline shift of 6 mm. (b) Preoperative cranial CT angiography, venous phase, showing right transverse and sigmoid sinuses patency and occlusion of the left transverse (arrowhead) and sigmoid (arrow) sinuses. (c) Preoperative cranial CT angiography, venous phase, showing right sigmoid sinus and jugular vein patency and occlusion of the sigmoid sinus (arrow) and jugular vein (arrowhead) on the left side. (d) Postoperative CT scan performed 24 h after the surgical procedure showing resolution of the midline shift and evacuation of the temporal hemorrhage through a left craniotomy with minimal amount of pneumocephalus.
See this image and copyright information in PMC

References

    1. Beslow LA, Abend NS, Smith SE. Cerebral sinus venous thrombosis complicated by cerebellar hemorrhage in a child with acute promyelocytic leukemia. J Child Neurol. 2009;24:110–4. - PubMed
    1. Bousser MG, Ferro JM. Cerebral venous thrombosis: An update. Lancet Neurol. 2007;6:162–70. - PubMed
    1. Bushnell C, Saposnik G. Evaluation and management of cerebral venous thrombosis. Continuum (Minneap Minn) 2014;20:335–51. - PMC - PubMed
    1. Ciccone M, Rigolin GM, Viglione GM, Borrelli M, Serino ML, Cuneo A. Thrombosis of the cerebral veins and sinuses in acute promyelocytic leukemia after all-trans retinoic acid treatment: A case report. Blood Coagul Fibrinolysis. 2008;19:721–3. - PubMed
    1. Dally N, Hoffman R, Haddad N, Sarig G, Rowe JM, Brenner B. Predictive factors of bleeding and thrombosis during induction therapy in acute promyelocytic leukemia-a single center experience in 34 patients. Thromb Res. 2005;116:109–14. - PubMed

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