Non-aneurysmal non-traumatic subarachnoid hemorrhage: think also in acute promyelocytic leukemia

Abstract

A 45-year-old woman presented with sudden severe excruciating headache. Medical history disclosed intermittent fever and weight loss in the past 3 months. No focal neurological deficits were seen. CT scan disclosed diffuse subarachnoid hemorrhage. Cranial CT angiography showed no intracranial aneurysms (Figure). Laboratory evaluation disclosed thrombocytopenia, anemia and abnormalities of white blood cell. Bone marrow biopsy confirmed acute promyelocytic leukemia (APML). Cerebrovascular disease is a frequent neurological complication in oncological patients, generally secondary to coagulopathies related to the neoplasm or drug-induced bleeding 1. Brain hemorrhage is most common in acute leukemias, especially in APML, and sometimes represents the presenting syndrome 2 .