title: A rare complication in a child undergoing chemotherapy for acute lymphoblastic leukemia: superior sagittal sinus thrombosis.
abstract: We report the case of a 4-year-old boy with acute lymphoblastic leukemia in high-risk group who suffered from generalized tonic-colonic seizure evolving into status epilepticus, and subsequent left hemiparesis during his first reinduction chemotherapy, consisting of dexamethasone, vincristine, l-asparaginase, and epirubicin. Superior sagittal sinus and cerebral venous thrombosis, predominantly in right side, were proved by brain magnetic resonance imaging. After aggressive treatment with low-molecular weight heparin (LMWH), left hemiparesis improved in 1 week. And he was fully ambulatory 3 weeks later. The second cycle of reinduction chemotherapy was conducted smoothly with the concomitant use of LMWH. This case illustrates the strong correlation of the rare thrombotic complication, superior sagittal sinus thrombosis, and hypercoagulable status secondary to combination use of l-asparaginase and corticosteroid. Early and vigilant recognition of superior sagittal sinus thrombosis and prompt anticoagulation with LMWH may prevent further neurological damage.
authors.affiliation: Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.
authors.forename: Ting-Yao
authors.initials: TY
authors.lastname: Wang
authors.forename: Hsiu-Ju
authors.initials: HJ
authors.lastname: Yen
authors.forename: Giun-Yi
authors.initials: GY
authors.lastname: Hung
authors.forename: Ming-Yun
authors.initials: MY
authors.lastname: Hsieh
authors.forename: Ren-Bin
authors.initials: RB
authors.lastname: Tang
mesh_terms: D001215:Asparaginase / Q000009:adverse effects; D002675:Child, Preschool; D006495:Heparin, Low-Molecular-Weight / Q000627:therapeutic use; D006801:Humans; D008297:Male; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000150:complications / Q000188:drug therapy*; D020225:Sagittal Sinus Thrombosis / Q000188:drug therapy / Q000209:etiology*
chemical_list: D006495:Heparin, Low-Molecular-Weight; D001215:Asparaginase