Section 2 - Other CNS disease related to underlying and secondary effects of malignancy

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Hematologic / Cerebrovascular : Intracranial hemorrhage

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Case 15

A 34 year old man with acute promyelocytic leukemia
While in remission, this patient was admitted with nuchal rigidity. MR with Gd (15A) showed pial enhancement consistent with leukemic meningitis, confirmed by cytology. He was given intrathecal ARA-C and developed thrombocytopenia, with subsequent LP's showing RBC's in the CSF.

Despite platelet transfusion, he continued to ooze into his subarachnoid space, and ultimately had a massive subarachnoid bleed. Noncontrast CT (15B) shows cisternal blood (arrows).

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