Cerebrovascular disease in acute leukemia: a clinicopathological study of 14 patients.
OBJECTIVE
Cerebrovascular disease (CVD) is a serious complication of acute leukemia, and the underlying conditions are different from the common risk factors for CVD. The aim of this study was to characterize the clinical and pathological features of CVD in patients with acute leukemia.


METHODS
In our series of 116 autopsied cases of acute leukemia during the period between January 1978 and December 1998, we had 14 patients who had CVD during the course of acute leukemia. The neuropathological and clinical features of those patients were examined.


RESULTS
Neuropathological examination showed hemorrhagic infarction due to disseminated aspergillosis or mucormycosis (5 cases), multiple hemorrhages due to leukemic cell infiltration (2 cases) and a single massive hemorrhage with petechial hemorrhages in various regions of the brain (4 cases). Three patients had CVD due to miscellaneous causes. Clinicopathological correlation revealed that fungal disseminations occurred under agranulocytosis, while leukemic cell infiltration occurred under a marked leukocyotosis (peripheral white blood cell count >100,000/microl). Four patients with coagulopathy, including three with disseminated intravascular coagulation (DIC) had a single massive hemorrhage.


CONCLUSIONS
Our study demonstrated that there were at least three types of CVD with specific clinicopathological features. Hemorrhagic infarction under agranulocyotosis was due to disseminated aspergillosis or mucormycosis. Multiple cerebral hemorrhages under marked leukocyotosis was due to leukemic cell infiltration into the brain. Massive cerebral hemorrhage was associated with coagulopathy including DIC.
Kawanami
Toru
T
Third Department of Internal Medicine, Yamagata University School of Medicine, Yamagata.
Kurita
Keiji
K
Yamakawa
Mitsunori
M
Omoto
Eijiro
E
Kato
Takeo
T
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000009:adverse effects; D001921:Brain / Q000473:pathology; D002561:Cerebrovascular Disorders / Q000175:diagnosis / Q000209:etiology* / Q000473:pathology*; D005260:Female; D006402:Hematologic Diseases / Q000209:etiology; D006801:Humans; D007938:Leukemia / Q000150:complications* / Q000188:drug therapy / Q000473:pathology*; D017254:Leukemic Infiltration / Q000209:etiology; D008297:Male; D008875:Middle Aged; D009181:Mycoses / Q000209:etiology*; D009460:Neurologic Examination; D012189:Retrospective Studies
D000970:Antineoplastic Agents