Multiple intracerebral hemorrhage as initial presentation of acute leukemia: A case report

Abstract

Intracerebral Hemorrhage had been a harbinger of morbidity and mortality in patients diagnosed with hematologic malignancy. Spontaneous Intracerebral hemorrhage prior to diagnosis is Leukemia however, is very rare and to our knowledge, only 6 have been reported. This is a case of a 21-year-old female, who was rushed to the emergency department due to decrease in sensorium. Patient had no significant headaches, no signs of increased intracranial pressure, and no signs of bruising or bleeding prior. Plain cranial CT scan revealed multiple intracerebral Hemorrhages of at least 18 in number. The Results of cytology revealed Acute Myeloid Leukemia. Several factors from previous comprehensive studies have been highlighted to increase the risk of Intracerebral Hemorrhage amongst these populations. Approximately 5% of patients with Acute leukemia will develop intracerebral hemorrhage and predictors for mortality have different in reported studies. Hyperleukocytosis is a strong consideration for increased mortality, the level of which still undetermined due to lack of literature. Although a probable association between Hyperleukocytosis and survival has been theorized, there is still insufficient data to conclude with certainty. More case reports or retrospective studies are needed so that an association may be established that can help in acute management of these patients.