Introduction Section 1 Section 2 Section 3 Conclusion and References


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

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Hematologic/ Cerebrovascular: Intracranial hemorrhage

Hematologic: Hematologic events are potentially among the most devastating CNS complications in patients with leukemia. They contribute greatly to the morbidity and mortality of leukemia. Different leukemic subtypes are associated with different coagulopathies, but in general, the acute leukemias are more frequently complicated by hematologic events. Table 3 below lists some of the coagulopathies that are known to occur in leukemia, alone or in combination. These complications may, but need not be associated with CNS leukemic involvement.

For a given patient, a particular coagulation imbalance can result in either a hypercoagulable state, or alternatively, a bleeding diathesis. Chemotherapy may contribute to hematologic complications. Some agents such as L-Asparaginase are known to be associated with thrombo-occlusive events. However, administration of agents not known to be so associated may trigger a hemorrhage or thrombotic event in a susceptible patient. Leukemics may also develop disseminated intravascular coagulation (DIC), manifested by hypofibrinogenemia, thrombocytopenia and bleeding from multiple body sites, including, possibly, the CNS (case 13).
Hemorrhage: Hemorrhage can be particularly dangerous and life threatening in leukemics. These bleeds can be intraaxial (cases 13 and case 14) or extraaxial (case 15), but intraparenchymal bleeds are the most feared. These tend to be multiple small rounded areas of hemorrhage in the subcortical white matter, often surrounded by a small collar of edema (case 13). Typically these patients present with a sudden onset of headache and/or neurologic deterioration, and possibly seizure. Patients with fulminant leukocytosis ("blast crisis"), are at particular risk for hemorrhage. In these patients, especially those with leukocyte counts greater than 300,000 per cu. mm, blast cell thrombi within small arterioles-"leukostasis"- can cause vascular destruction, and lead to massive hemorrhage (case 14). Spinal subdural hematoma may occur as a complication of diagnostic lumbar puncture, in patients with thrombocytopenia.


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