Neurosurgical management of L-asparaginase induced haemorrhagic stroke.
Affiliation
Department of Neurosurgery, Cork University Hospital, Cork, Ireland.Issue Date
2012MeSH
AdultAntineoplastic Agents
Asparaginase
Craniotomy
Decompression, Surgical
Diagnosis, Differential
Glasgow Coma Scale
Humans
Intracranial Hemorrhages
Intracranial Pressure
Male
Precursor Cell Lymphoblastic Leukemia-Lymphoma
Tomography, X-Ray Computed
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Neurosurgical management of L-asparaginase induced haemorrhagic stroke. 2012, 2012: BMJ Case RepJournal
BMJ case reportsDOI
10.1136/bcr.11.2011.5240PubMed ID
22605598Abstract
The authors describe a case of L-asparaginase induced intracranial thrombosis and subsequent haemorrhage in a newly diagnosed 30-year-old man with acute lymphoblastic leukaemia who was successfully managed by surgical intervention. At presentation, he had a Glasgow Coma Score of 7/15, was aphasic and had dense right hemiplegia. Neuroimaging revealed an acute anterior left middle cerebral artery infarct with parenchymal haemorrhagic conversion, mass effect and subfalcine herniation. He subsequently underwent left frontal craniotomy and evacuation of large frontal haematoma and decompressive craniectomy for cerebral oedema. Six months postoperatively he underwent titanium cranioplasty. He had made good clinical recovery and is currently mobilising independently with mild occasional episodes of expressive dysphasia, difficulty with fine motor movement on the right side, and has remained seizure free. This is the first documented case of L-asparaginase induced haemorrhagic stroke managed by neurosurgical intervention. The authors emphasise the possible role of surgery in managing chemotherapy induced intracranial complications.Item Type
ArticleLanguage
enISSN
1757-790Xae974a485f413a2113503eed53cd6c53
10.1136/bcr.11.2011.5240
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