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Related Experiment Video

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Hyperleukocytosis-induced stroke and tonsillar herniation: Case report.

Hasan Hashem1, Baha'eddin A Muhsen2

  • 1Department of Pediatrics, Division of Pediatric Hematology Oncology and Bone Marrow Transplantation, King Hussein Cancer Center, Amman, Jordan.

Annals of Medicine and Surgery (2012)
|September 20, 2021
PubMed
Summary

Acute ischemic stroke in children with leukemia is rare but serious. This case highlights hyperleukocytosis as a cause, emphasizing prompt management for a good outcome in pediatric leukemia patients.

Keywords:
HyperleukocytosisHyperviscosityIschemic strokeLeukemiaTonsillar herniation

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Area of Science:

  • Pediatric Hematology Oncology
  • Neurology
  • Vascular Medicine

Background:

  • Acute ischemic stroke is a rare but significant complication in pediatric leukemia.
  • Central nervous system leukemic involvement and chemotherapy are common causes, while hyperleukocytosis-induced stroke is seldom reported.

Observation:

  • A 2-year-old boy with T-cell acute lymphoblastic leukemia presented with hyperleukocytosis (320x10^9/L).
  • He developed neurological deficits including altered mental status and limb weakness, with MRI revealing multifocal posterior circulation infarctions and tonsillar herniation.
  • Cerebrospinal fluid analysis excluded leukemic infiltration, and thrombophilia workup was negative.

Findings:

  • Hyperviscosity secondary to hyperleukocytosis was identified as the likely cause of stroke.
  • Conservative management with hydration and dexamethasone led to significant neurological improvement.
  • Follow-up MRI demonstrated resolution of infarcts, and the patient achieved remission.

Implications:

  • Early recognition and prompt management of hyperleukocytosis-induced stroke are crucial in pediatric leukemia.
  • This case underscores the importance of considering hyperviscosity in pediatric leukemia patients presenting with neurological symptoms.
  • Aggressive supportive care and timely intervention can lead to favorable outcomes in these complex cases.