[Superior sagittal sinus thrombosis during remission induction therapy for acute lymphoblastic leukemia].
Superior sagittal sinus thrombosis (SSST) has been reported to be caused by coagulopathy following oral contraceptive therapy, DIC, infection around the sinus, compression from a tumor, infiltration of tumor, and an inherited deficiency of proteins C and S, but SSST associated with hematological malignancies and L-asparaginase (L-Asp) therapy is rare. We report a case of an adult patient with acute lymphoblastic leukemia (ALL) who developed SSST during the remission induction therapy. A 25-year-old man was admitted with left facial nerve palsy and, following bone marrow aspiration and lumbar puncture, he was diagnosed as having T-ALL with CNS involvement. He received a 1-AdVP regimen as remission induction therapy and intrathecal administration of methotrexate and cytarabine. On day 29, he had a generalized convulsion and SSST was demonstrated by imaging tests. Lymphoid malignancy (ALL in particular), the use of L-Asp, CNS involvement, and intrathecal chemotherapy might be risk factors for the occurrence SSST. When a patient with those factors develops any neurological symptoms, we should pay attention to the occurrence of SSST, as well as stroke or CNS involvement, though SSST is rare.
Yoshimi
Akihide
A
Division of Hematology, NTT Kanto Medical Center.
Taoka
Kazuki
K
Nakasone
Hideki
H
Iijima
Kimiko
K
Kida
Michiko
M
Iki
Seiko
S
Urabe
Akio
A
Usuki
Kensuke
K
D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage* / Q000009:adverse effects*; D001215:Asparaginase / Q000008:administration & dosage* / Q000009:adverse effects*; D016543:Central Nervous System Neoplasms / Q000150:complications / Q000628:therapy*; D003520:Cyclophosphamide / Q000008:administration & dosage; D003561:Cytarabine / Q000008:administration & dosage / Q000009:adverse effects; D004317:Doxorubicin / Q000008:administration & dosage; D005158:Facial Paralysis / Q000209:etiology; D006801:Humans; D007278:Injections, Spinal; D008297:Male; D008727:Methotrexate / Q000008:administration & dosage / Q000009:adverse effects; D008942:Mitoxantrone / Q000008:administration & dosage; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000150:complications / Q000628:therapy*; D011239:Prednisolone / Q000008:administration & dosage; D012074:Remission Induction; D012307:Risk Factors; D020225:Sagittal Sinus Thrombosis / Q000209:etiology*; D014750:Vincristine / Q000008:administration & dosage
D003561:Cytarabine; D014750:Vincristine; D004317:Doxorubicin; D003520:Cyclophosphamide; D011239:Prednisolone; D008942:Mitoxantrone; D001215:Asparaginase; D008727:Methotrexate