Posted: Friday, May 28, 2021
A case study presented in the Journal of Integrative Neuroscience describes a patient with acute myeloid leukemia (AML) whose first manifestation of the disease was a superior sagittal sinus thrombosis. The cerebral venous sinus thrombosis was determined to be related to Trousseau syndrome, a type of migratory thrombophlebitis associated with abnormal coagulation and often an underlying malignancy.
“In recent years, it has been found that patients with hematologic malignancies have similar or even higher thrombotic complications than those with solid tumors, mainly including multiple myeloma, acute leukemia, and central nervous system lymphoma,” noted Jing-Zhe Han, MD, of Harrison International Peace Hospital, China, and colleagues.
The patient, a 44-year-old woman, initially presented with blurred vision and headaches that had persisted for 2 months and for 10 days, respectively. Her vision had deteriorated over that period until she could not distinguish objects in her sight, and her headaches were accompanied by nausea and vomiting.
A CT scan of the head revealed several unusually located cerebral hemorrhages, but they did not entirely account for the patient’s symptoms. Upon examination of the ocular fundus, bilateral optic papillae edema was noted, which suggested elevation of intracranial pressure when considered with the patient’s headache symptom and binocular abduction nerve limitation. Because this finding appeared to be at odds with the observed level of intracranial bleeding, further investigation was done, revealing MRI-confirmed intracranial venous sinus thrombosis.
The patient’s bloodwork indicated thrombocytopenia and an increase in leukocytes. A bone marrow puncture was performed, and the patient was diagnosed with AML. While hospitalized, she received chemotherapy plus low–molecular-weight heparin. Following discharge, she was switched to warfarin. The patient’s leukemia was resolved after two chemotherapy courses and had not recurred at a follow-up of 6 months, at which point her headache and blurred vision had also resolved.
Disclosure: The study authors reported no conflicts of interest.