Cerebral dural sinus thrombosis in acute lymphoblastic leukemia with early diagnosis by fast fluid-attenuated inversion recovery (FLAIR) MR image: a case report and review of the literature

Abstract

Cerebral dural sinus thrombosis (CDST) is a very rare complication of acute lymphoblastic leukemia (ALL) in adult patients. A 23-year-old man with ALL developed dizziness, headache, diplopia, limb weakness, and a sensation of fullness in his head after his second induction chemotherapy with doxorubicin, prednisolone, and vincristine. Examinations of the peripheral blood, bone marrow, and cerebrospinal fluid showed no recurrent leukemic cells. Magnetic resonance (MR) imaging of the brain disclosed unexpected CDST at the left transverse sinus, which was seen only on the fast fluid-attenuated inversion recovery (FLAIR) sequence. His symptoms were relieved soon after treatment with heparin. MR imaging with FLAIR performed a second time 7 days later showed complete disappearance of the thrombosis. The patient was treated continuously with oral anticoagulant therapy and the symptoms did not recur. CDST can be diagnosed in its early phase by MR studies with FLAIR images. Anticoagulant therapy can be administered safely without precipitating the occurrence of infarction hemorrhage at such an early stage of CDST.

Clinical Course of Cerebral Venous Thrombosis in Adult Acute Lymphoblastic Leukemia

“…Inflammatory effects of MTX may induce local thrombosis. 8,15 However, in the GIMEMA study, no intrathecal MTX was administered but the incidence of CVT during the first remission induction cycle was still 2.1%. 16 The increased risk may also be explained by effects of the intrathecal administration.…”

Neuroimaging in Pediatric Leukemia and Lymphoma: Differential Diagnosis

“…Contributing factors include CNS infiltration, leukostasis, and chemotherapeutic agents such as l-asparaginase and vincristine. Up to 2% of patients treated with l-asparaginase develop hemorrhagic or nonhemorrhagic infarcts, usually secondary to sinovenous occlusion (24,25). Transient protein S deficiency induced by l-asparaginase has been advocated as a causal mechanism (26).…”

Magnetic Resonance Imaging of Neurologic Complications through the Treatment of Childhood Leukaemia and Lymphoma

“…Acute cerebral infarction in a 4-year-old boy with unconsciousness and right hemiparesis who was undergoing chemotherapy for acute lymphoblastic leukaemia. Diffusion-weighted magnetic resonance image (A) and apparent diffusion coefficient map (B) demonstrate acute infarction in the left frontal lobe and left basal ganglia (arrows).sequences, contrast-enhanced MRI, and MR venography demonstrate the absence of flow void in the affected dural sinuses(Figure 7)[9]. Antiaggregant and anticoagulant therapies are recommended for the treatment of dural venous thrombosis.…”