Takamatsu K, Takizawa T
Department of Neurology, Ohta Memorial Hospital, Fukuyama, Japan.
No To Shinkei. 1990 Oct;42(10):987-90.
A case was reported in which the patient, whose leukemic cells were not found in the peripheral blood, died several days after the onset of cerebral sinus thrombosis, and after the autopsy acute leukemia was diagnosed. The patient, a 68-year-old female, was admitted with clouding of the consciousness. In the initial examination, she was semicomatose, pendulum-like movement was seen in the eyeballs, and hemorrhagic maculae on the trunk and extremities. Among the laboratory findings, WBC was 8, 100 (B 1, St 6, S 77, L 14, Mon 2), RBC 375 x 10(4), Hb 12.5, Ht 37, PLT 3.5 x 10(4), PT 15.6, PTT 68, Fib 158, FDP 10 and AT-III 75. In contrast enhanced CT, an empty triangular sign was observed. On the third hospital day, the patient died of a cerebral hernia. On autopsy, thrombosis was found in the bilateral sigmoid sinus. In the cerebral tissue, congestion was throughout the brain, and many leukemic cells were seen in the dilated blood vessels, but there was no infiltration into the parenchyma. The bone marrow, hypercellular, showed many intermediate type and blastic myeloid cells. The main neurological complications of leukemia are leukemic infiltration and intracranial hemorrhages. Capillary obstructions associated with the disseminated intravascular coagulation (DIC) syndrome are rarely experienced, but obstructions of thick arteries or thick veins such as venous sinuses are seldom seen in general, and most reports of such cases were those resulting from chemotherapy after making a diagnosis of acute leukemia. In the literature, there have been only two reports in our literature.(ABSTRACT TRUNCATED AT 250 WORDS)
报告了一例患者,其外周血中未发现白血病细胞,在发生脑静脉窦血栓形成数天后死亡,尸检后诊断为急性白血病。该患者为68岁女性,因意识模糊入院。初始检查时,她处于半昏迷状态,眼球有钟摆样运动,躯干和四肢有出血斑。实验室检查结果显示,白细胞计数为8100(嗜碱性粒细胞1%,杆状核粒细胞6%,分叶核粒细胞77%,淋巴细胞14%,单核细胞2%),红细胞计数375×10⁴,血红蛋白12.5,血细胞比容37%,血小板计数3.5×10⁴,凝血酶原时间15.6秒,活化部分凝血活酶时间68秒,纤维蛋白原158mg/dl,纤维蛋白降解产物10μg/ml,抗凝血酶III 75%。增强CT检查发现空三角征。入院第三天,患者死于脑疝。尸检发现双侧乙状窦血栓形成。脑组织中全脑充血,在扩张的血管中可见许多白血病细胞,但实质内无浸润。骨髓细胞增多,可见许多中间型和原始髓样细胞。白血病的主要神经并发症是白血病浸润和颅内出血。与弥散性血管内凝血(DIC)综合征相关的毛细血管阻塞很少见,但一般很少见到粗大动脉或粗大静脉如静脉窦的阻塞,大多数此类病例报告是在诊断为急性白血病后化疗所致。在文献中,我们的文献中仅有两篇报道。(摘要截短至250字)