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Open Access Research article

Intracranial hemorrhage in adult patients with hematological malignancies

Chien-Yuan Chen1*, Chan-Hwei Tai2, Aristine Cheng1, Hung-Chang Wu3, Woei Tsay1, Jia-Hau Liu14, Pey-Ying Chen5, Shang-Yi Huang1, Ming Yao1, Jih-Luh Tang14 and Hwei-Fang Tien1*

Author Affiliations

1 Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan

2 Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan

3 Department of Internal Medicine, Division of Hematology and Oncology, Chi-Mei Hospital, Tainan, Taiwan

4 Tai-Cheng Stem Cell Therapy Center, National Taiwan University Hospital, Taipei, Taiwan

5 Department of Nursing, National Taiwan University Hospital, Taipei, Taiwan

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BMC Medicine 2012, 10:97  doi:10.1186/1741-7015-10-97

Published: 29 August 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