Journal of Clinical Case Reports

Multiple Intracerebral Hemorrhages Prior to the Diagnosis of Acute Lymphocytic Leukemia

Abstract

Kinoshita Yu, Hidekazu Horiuchi, Naoki Kato and Ching-Chan Su

Intracerebral Hemorrhage (ICH) can be seen in patients with acute leukemia, however, it is extremely rare to present ICH as the initial presentation in previously undiagnosed acute leukemia. Only four cases were reported in the English literature. This 17-year-old male was admitted with sudden onset of headache, nausea and vomiting. Three days before this admission, he visited an ophthalmological department for bilateral blurred vision. Bilateral retinal hemorrhages were detected by the funduscopic examination; however, further examinations were not performed at that time. On arrival at our hospital, his Glasgow Coma Scale was 8 (E2, V3, M3) and urgent head CT scan showed multiple Computed Tomography (CT) head demonstrated multiple ICHs. On admission, his White Blood Cell (WBC) count was 584,000/μl with evidence of blast crisis, and platelet count was 18,000/μl. Despite urgent platelet and plasma transfusions, his conscious level deteriorated, and the patient died 12 hours after the admission due to respiratory failure. The importance of correct diagnosis and early management of leukemia is emphasized, which may prevent blast crisis and disseminated intravascular coagulation leading to fatal ICH.