Hyperleukocytosis in Elderly Acute Myeloid Leukemia presented with Cortical Blindness and Left Hemiparesis
Keywords:
acute myeloid leukemia, cerebral infarction, cortical blindness, hemiparesis, hyperleukocytosisAbstract
Hyperleukocytosis is defined as a white blood cell count greater than 100,000/mL found in patients with acute myeloid leukemia and acute lymphoblastic leukemia. It can cause 3 complications including leukostasis, disseminated intravascular coagulation (DIC), and tumor lysis syndrome. Leukostasis can present with neurological symptoms such as headache, confusion, somnolence, and rarely hemiparesis.
Case: A 84-year-old Thai female with hypertension, hyperlipidemia, and breast cancer (in remission) presented with acute left hemiparesis for 2 hours and bilateral vision loss for 16 hours. CT brain revealed bilateral occipital lobe infarction which is more on the right side and bilateral posterior cerebral artery (PCA) occlusion. Complete blood count showed white blood cells of 142,850 cells/mm3 (blast 99%). She was diagnosed with acute myeloid leukemia with hyperleukocytosis and treated with chemotherapy and aggressive intravenous hydration. There was an improvement in her left hemiparesis but not in blindness.
Acute cerebral infarction with bilateral PCA occlusion presented with hemiparesis and cortical blindness in the elderly can be caused by hyperleukocytosis associated with acute myeloid leukemia, though it is a rare presentation.
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