Hyperleukocytosis in Elderly Acute Myeloid Leukemia presented with Cortical Blindness and Left Hemiparesis


  • Chonvipa Siriyutwattana -
  • Pirada Witoonpanich


acute myeloid leukemia, cerebral infarction, cortical blindness, hemiparesis, hyperleukocytosis


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.


Röllig C, Ehninger G. How I treat hyperleukocytosis in acute myeloid leukemia. Blood. 2015;125(21):3246-3252.

Giammarco S, Chiusolo P, Piccirillo N L., et al. Hyperleukocytosis and leukostasis: management of a medical emergency. Expert Rev Hematol. 2017;10(2):147-154.

Bewersdorf JP, Zeidan AM. Hyperleukocytosis and Leukostasis in Acute Myeloid Leukemia: Can a Better Understanding of the Underlying Molecular Pathophysiology Lead to Novel Treatments? Cells. 2020;9(10):2310.

Novotny JR, Müller-Beissenhirtz H, Herget-Rosenthal S, et al. Grading of symptoms in hyperleukocytic leukaemia: a clinical model for the role of different blast types and promyelocytes in the development of leukostasis syndrome. Eur J Haematol. 2005;74(6):501-10.

Ali AM, Mirrakhimov AE, Abboud CN, et al. Leukostasis in adult acute hyperleukocytic leukemia: a clinician's digest. Hematol Oncol. 2016;34(2):69-78.

Lana-Peixoto MI, Lana-Peixoto MA. The central nervous system leukemia: a clinical and pathological study. Arq Neuropsiquiatr. 1985;43(1):1-10.

Hashem H, Muhsen BA. Hyperleukocytosis-induced stroke and tonsillar herniation: Case report. Ann Med Surg (Lond). 2021;70:102776.

Dutcher JP, Schiffer CA, Wiernil PH. Hyperleukocytosis in adult acute nonlymphocytic leukemia: impact on remission rate and duration, and survival. J clinical Oncol 1987;5(9):1364-1372.

Hug V, Keating M, McCredie K, Hester J, et al. Clinical course and response to treatment of patients with acute myelogenous leukemia presenting with a high leukocyte count. Cancer 1983; 52(5): 773– 779.

Vaughan WP, Kimball AW, Karp JE, et al. Factors affecting survival of patients with acute myelocytic leukemia presenting with high WBC counts. Cancer Treat Rep 1981; 65(11–12): 1007-1013.

Creutzig U, Ritter J, Budde M, et al. Early deaths due to hemorrhage and leukostasis in childhood acute myelogenous leukemia. Associations with hyperleukocytosis and acute monocytic leukemia. Cancer 1987; 60(12): 3071-3079.

Bunin NJ, Pui CH. Differing complications of hyperleukocytosis in children with acute lymphoblastic or acute nonlymphoblastic leukemia. J Clin Oncol 1985; 3(12): 1590-1595.

Cuttner J, Holland JF, Norton L, Ambinder E, Button G, Meyer RJ. Therapeutic leukapheresis for hyperleukocytosis in acute myelocytic leukemia. Med Pediatr Oncol 1983; 11(2): 76-78.

Smith A, Roman E, Howell D, et al. Haematological Malignancy Research Network. The Haematological Malignancy Research Network (HMRN): a new information strategy for population based epidemiology and health service research. Br J Haematol. 2010;148(5):739-5.




How to Cite

Siriyutwattana C, Witoonpanich P. Hyperleukocytosis in Elderly Acute Myeloid Leukemia presented with Cortical Blindness and Left Hemiparesis. J Thai Stroke Soc [Internet]. 2022 Dec. 16 [cited 2024 Jun. 20];21(3):54. Available from: https://he01.tci-thaijo.org/index.php/jtss/article/view/259594