[Chronic myeloid leukemia complicated with cerebellar hemorrhage and acute hydrocephalus successfully treated with imatinib and intensive supportive care].
We report a case of a 46-year-old female demonstrating general fatigue and visual disturbances with retinal bleeding. She had a white blood cell count of 419,300/mm. Thereafter, she developed vomiting associated with vertigo caused by cerebellar hemorrhage, deteriorating to acute hydrocephalus secondary to obstruction of the cerebral aqueduct. Emergency procedures for cerebral protection, such as hyperventilation, administration of mannitol, and barbiturate coma, were performed. Bone marrow examination showed a positive BCR-ABL/t(9;22)(q34;q11) chromosomal translocation detected by FISH and RT-PCR (masked Ph) and she was diagnosed as having chronic myeloid leukemia (CML) in the chronic phase (CP). She was administered Ara-C, together with imatinib 600 mg/d through a nasogastric tube. Eight days later, she underwent successful extubation and recovered without any neurological defect. She was maintained on imatinib 400 mg/d and demonstrated a major molecular response at 15 months. Physicians need to be aware that brain hemorrhage may develop as an initial symptom of CML patients in CP.
Department of Internal Medicine, Matsuyama Red-Cross Hospital, Japan.
Tsuyoshi
T
Muta
Yuichiro
Y
Sawada
Yasunori
Y
Moriyama
Yasuko
Y
Seike
Takahito
T
Tokuyama
Yoko
Y
Ueda
Tomoaki
T
Fujisaki
D000208:Acute Disease; D000970:Antineoplastic Agents / Q000008:administration & dosage*; D001549:Benzamides; D002531:Cerebellum; D002543:Cerebral Hemorrhage / Q000209:etiology* / Q000628:therapy*; D003131:Combined Modality Therapy; D003422:Critical Care; D003561:Cytarabine / Q000008:administration & dosage; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D006849:Hydrocephalus / Q000209:etiology* / Q000628:therapy*; D000068877:Imatinib Mesylate; D015464:Leukemia, Myelogenous, Chronic, BCR-ABL Positive / Q000150:complications* / Q000175:diagnosis / Q000628:therapy*; D018921:Leukostasis / Q000150:complications; D008353:Mannitol / Q000008:administration & dosage; D008875:Middle Aged; D010879:Piperazines / Q000008:administration & dosage*; D011743:Pyrimidines / Q000008:administration & dosage*; D012121:Respiration, Artificial
D000970:Antineoplastic Agents; D001549:Benzamides; D010879:Piperazines; D011743:Pyrimidines; D003561:Cytarabine; D008353:Mannitol; D000068877:Imatinib Mesylate