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BMC Med. 2012; 10: 97.
Published online Aug 29, 2012. doi:  10.1186/1741-7015-10-97
PMCID: PMC3482556
Intracranial hemorrhage in adult patients with hematological malignancies
Chien-Yuan Chen,corresponding author1 Chan-Hwei Tai,2 Aristine Cheng,1 Hung-Chang Wu,3 Woei Tsay,1 Jia-Hau Liu,1,4 Pey-Ying Chen,5 Shang-Yi Huang,1 Ming Yao,1 Jih-Luh Tang,1,4 and Hwei-Fang Tiencorresponding author1
1Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
2Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan
3Department of Internal Medicine, Division of Hematology and Oncology, Chi-Mei Hospital, Tainan, Taiwan
4Tai-Cheng Stem Cell Therapy Center, National Taiwan University Hospital, Taipei, Taiwan
5Department of Nursing, National Taiwan University Hospital, Taipei, Taiwan
corresponding authorCorresponding author.
Chien-Yuan Chen: chienyuanchen/at/ntu.edu.tw; Chan-Hwei Tai: chtai1502/at/ntu.edu.tw; Aristine Cheng: aristine/at/hotmail.com; Hung-Chang Wu: hungchang.wu/at/gmail.com; Woei Tsay: woei12/at/gamil.com; Jia-Hau Liu: b8702037/at/gmail.com; Pey-Ying Chen: piy-ing/at/yahoo.com.tw; Shang-Yi Huang: sy551225/at/ms7.hinet.net; Ming Yao: yaoming/at/ntu.edu.tw; Jih-Luh Tang: tangjh/at/ntu.edu.tw; Hwei-Fang Tien: tienhf/at/ntu.edu.tw
Received February 3, 2012; Accepted August 29, 2012.
Abstract
Background
Clinical characteristics and outcomes of intracranial hemorrhage (ICH) among adult patients with various hematological malignancies are limited.
Methods
A total of 2,574 adult patients diagnosed with hematological malignancies admitted to a single university hospital were enrolled into this study between 2001 and 2010. The clinical characteristics, image reports and outcomes were retrospectively analyzed.
Results
A total of 72 patients (48 men and 24 women) with a median age of 56 (range 18 to 86) had an ICH. The overall ICH incidence was 2.8% among adult patients with hematological malignancies. The incidence of ICH was higher in acute myeloid leukemia (AML) patients than in patients with other hematological malignancies (6.3% vs 1.1%, P = 0.001). ICH was more common among patients with central nervous system (CNS) involvement of lymphoma than among patients with CNS involved acute leukemia (P <0.001). Sites of ICH occurrence included the cerebral cortex (60 patients, 83%), basal ganglia (13 patients, 18%), cerebellum (10 patients, 14%), and brainstem (5 patients, 7%). A total of 33 patients (46%) had multifocal hemorrhages. In all, 56 patients (77%) had intraparenchymal hemorrhage, 22 patients (31%) had subdural hemorrhage, 15 patients (21%) had subarachnoid hemorrhage (SAH), and 3 patients (4%) had epidural hemorrhage. A total of 22 patients had 2 or more types of ICH. In all, 46 (64%) patients died of ICH within 30 days of diagnosis, irrespective of the type of hematological malignancy. Multivariate analysis revealed three independent prognostic factors: prolonged prothrombin time (P = 0.008), SAH (P = 0.021), and multifocal cerebral hemorrhage (P = 0.026).
Conclusions
The incidence of ICH in patients with AML is higher than patients with other hematological malignancies. But in those with intracranial malignant disease, patients with CNS involved lymphoma were more prone to ICH than patients with CNS involved acute leukemia. Mortality was similar regardless of the type of hematological malignancy. Neuroimaging studies of the location and type of ICH could assist with prognosis prediction for patients with hematological malignancies.
Keywords: central nervous system (CNS) involvement, cerebral hemorrhage, hematological malignancy, prognosis, neuroimage
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