title: Acute Promyelocytic Leukemia Presenting as Focal Neurologic Findings and Deteriorating Mental Status.
abstract: BACKGROUND
  Acute promyelocytic leukemia (APL) is a rare but particularly malignant form of acute leukemia that is characterized by a rapid progression to fatal hemorrhage. Survival rates of patients with APL have increased with the introduction of all-trans retinoic acid (ATRA), but early deaths caused by hemorrhage still persist.
  
  
  METHODS
  A man with undiagnosed APL presenting with focal neurologic findings and deteriorating altered mental status caused by an intracranial hemorrhage is discussed. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: It is important to consider APL when diagnosing etiologies for intracranial hemorrhage. In addition to standard care, early administration of ATRA is recommended upon clinical suspicion of the disease.
authors.affiliation: Department of Emergency Medicine, Yale University School of Medicine, New Haven, Connecticut.
authors.forename: Matthew
authors.initials: M
authors.lastname: Dolan
authors.affiliation: Department of Emergency Medicine, Yale University School of Medicine, New Haven, Connecticut.
authors.forename: Christine
authors.initials: C
authors.lastname: Ngaruiya
mesh_terms: D001792:Blood Platelets; D003243:Consciousness; D004636:Emergency Service, Hospital / Q000458:organization & administration; D005169:Factor VIII / Q000008:administration & dosage / Q000627:therapeutic use; D005340:Fibrinogen / Q000008:administration & dosage / Q000627:therapeutic use; D006801:Humans; D020300:Intracranial Hemorrhages / Q000150:complications / Q000175:diagnosis* / Q000209:etiology; D015473:Leukemia, Promyelocytic, Acute / Q000150:complications / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000150:complications* / Q000209:etiology; D013921:Thrombocytopenia / Q000209:etiology; D014057:Tomography, X-Ray Computed / Q000379:methods; D014212:Tretinoin / Q000494:pharmacology / Q000627:therapeutic use
chemical_list: C026912:cryoprecipitate coagulum; D014212:Tretinoin; D005169:Factor VIII; D005340:Fibrinogen
keywords: APL; ATRA; acute promyelocytic leukemia; all-trans retinoic acid; hemorrhage; intracranial hemorrhage; leukemia