Olivieri Martin, Kurnik Karin, Heinen Florian, Schmid Irene, Hoffmann Florian, Reiter Karl, Gerstl Lucia
Dr. von Hauner Children's Hospital, LMU Munich, Germany.
Glob Pediatr Health. 2016 Dec 13;3:2333794X16681934. doi: 10.1177/2333794X16681934. eCollection 2016.
Acute ischemic stroke (AIS) is a rare event in infancy. Besides vasculopathy, thrombophilia, or cardiac disorders, cancer and chemotherapy are known predisposing factors for AIS. Leukemia can be associated with different abnormal coagulation parameters, but severe bleeding or thrombosis occurs rarely. We report the case of a 2-year-old boy who was presented to our emergency ward after a prolonged seizure with right sided postictal hemiparesis. Cranial computed tomography scan revealed a large infarction and edema due to thrombosis of the left carotid artery, the middle cerebral artery, and the anterior cerebral artery. Laboratory workup showed 196 g/L leukocytes with 75% myeloid blast cells. Immediate exchange transfusion, hydration, and chemotherapy with cytarabine were started. During the hospital course intracranial pressure increased and the patient developed a unilateral dilated pupil unresponsive to light. Cranial computed tomography scan revealed a new infarction in the right middle cerebral artery territory. Refractory increased intracranial pressure and brain stem herniation developed, and the child died 3 days after admission to hospital. Seizures with postictal hemiparesis due to cerebral infarction can be a rare manifestation of acute myeloid leukemia. Leukocytosis and cancer-induced coagulopathy are main reasons for thrombosis and/or hemorrhage. High leukocyte counts need immediate interventions with hydration, careful chemotherapy, and perhaps exchange transfusion or leukapharesis. In the presence of thrombosis, anticoagulation must be discussed despite the risk of bleeding due to hyperfibrinolysis and low platelet counts. Mortality may be reduced by awareness of this rare presentation of leukemia and prompt institution of leucoreductive treatment.
急性缺血性卒中（AIS）在婴儿期是一种罕见事件。除血管病变、血栓形成倾向或心脏疾病外，癌症和化疗是已知的AIS诱发因素。白血病可伴有不同的异常凝血参数，但严重出血或血栓形成很少发生。我们报告一例2岁男孩，在长时间癫痫发作后出现右侧发作后偏瘫，被送至我们的急诊病房。头颅计算机断层扫描显示，由于左侧颈动脉、大脑中动脉和大脑前动脉血栓形成，出现大面积梗死和水肿。实验室检查显示白细胞计数为196 g/L，髓系原始细胞占75%。立即开始进行换血输血、补液，并使用阿糖胞苷进行化疗。在住院过程中，颅内压升高，患者出现单侧瞳孔散大，对光无反应。头颅计算机断层扫描显示右侧大脑中动脉区域出现新的梗死灶。出现难治性颅内压升高和脑干疝，患儿在入院3天后死亡。脑梗死所致癫痫发作伴发作后偏瘫可能是急性髓系白血病的一种罕见表现。白细胞增多症和癌症诱发的凝血病是血栓形成和/或出血的主要原因。高白细胞计数需要立即采取补液、谨慎化疗，或许还需要进行换血输血或白细胞去除术等干预措施。在存在血栓形成的情况下，尽管存在由于纤维蛋白溶解亢进和血小板计数低导致出血的风险，但仍必须讨论抗凝治疗。认识到白血病的这种罕见表现并及时进行白细胞减少治疗，可能会降低死亡率。
