title: Extensive sinovenous thrombosis and hemorrhagic infarction during therapy for T-cell acute lymphoblastic leukemia.
abstract: Sinovenous thrombosis (SVT) is a well-recognized and serious complication in children treated for acute leukemia. This frequently occurs during or immediately upon completion of induction therapy and is commonly attributed to asparaginase therapy.Headache is the first and most common clinical symptom to occur during the early development of SVT. With advancement of the thrombosis, the clinical symptoms can progress to increased sleepiness, focal neurological deficit, seizures, and altered consciousness. We report the case of a 4-year-old girl who presented after several days of headaches and anorexia, which then progressed to seizures, left-sided weakness, and altered consciousness. She was later found to have a widespread and occlusive SVT with right cerebral hemorrhagic infarction. This case is notable for the extensive nature of the cerebral SVT and the child's complete clinical recovery from the neurological event. The report discusses the relation of the thrombosis and leukemia and also emphasizes the importance of early recognition and prompt management, while incorporating a collaborative multidisciplinary approach to prevent long-term consequences.
authors.affiliation: Department of Pediatrics, Loyola University Medical Center, Maywood, IL, USA.
authors.forename: Rahul
authors.initials: R
authors.lastname: Bhatia
authors.forename: Howard D
authors.initials: HD
authors.lastname: Rowley
authors.forename: Jennifer C
authors.initials: JC
authors.lastname: Mosher
authors.forename: Nila H
authors.initials: NH
authors.lastname: Alsheik
authors.forename: Beverly
authors.initials: B
authors.lastname: Aagaard-Kienitz
authors.forename: Carol D
authors.initials: CD
authors.lastname: Diamond
authors.forename: Bermans J
authors.initials: BJ
authors.lastname: Iskandar
authors.forename: Antoinette
authors.initials: A
authors.lastname: Peters
authors.forename: Juan P
authors.initials: JP
authors.lastname: Boriosi
authors.forename: Neha J
authors.initials: NJ
authors.lastname: Patel
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D020520:Brain Infarction / Q000209:etiology* / Q000628:therapy; D002675:Child, Preschool; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D020300:Intracranial Hemorrhages / Q000209:etiology* / Q000628:therapy; D008279:Magnetic Resonance Imaging; D054218:Precursor T-Cell Lymphoblastic Leukemia-Lymphoma / Q000150:complications* / Q000628:therapy*; D012851:Sinus Thrombosis, Intracranial / Q000209:etiology* / Q000628:therapy