Severe spontaneous acute arterial subdural hematoma as an initial symptom of chronic myeloid leukemia

Acute subdural hematoma (SDH) is a rare occurrence in chronic myeloid leukemia (CML) patients with only two cases reported in literature. However, sudden severe acute SDH caused by CML has not been reported on. Our patient was admitted for 'sudden unconsciousness for more than 1 hour'. Computed tomography (CT) angiography revealed a large amount of acute SDH on the left side. Physical exam showed the patient's left pupil was dilated and signs of cerebral herniation were present. The preoperative coagulation profile was normal. Emergency craniotomy for hematoma clearance and decompression was performed. During the surgery, a ruptured cerebral artery was located in the perisylvian region and hemostasis was achieved through electrocautery. Pre-operative white blood count was 58,100 cell/µl, with post-operative bone marrow examination、cytogenetic analysis and RT-PCR detection revealing a diagnosis of CML, for which hydroxyurea chemotherapy was initiated. Leukocyte count of the patient gradually returned to normal. After 24 days, the patient regained consciousness and on day 30, repeat CT scan showed no SDH recurrence. The patient recovered with no neurological deficits and achieved a good prognosis.