Cerebral Venous Sinus Thrombosis in Acute Lymphoblastic Leukemia: A Case Reports

Authors:
TANADI Aristo, SETIAWAN Singgih, FAHMI Iqbal, SIAGIAN Sondang, MULATSIH Sri, SUTARYO
Sutaryo
Department of Child Health, Faculty of Medicine, Universitas Gadjah Mada - Dr. Sardjito General
Hospital, Yogyakarta, Indonesia

Email:
aristotanadi@live.com

Background: Thromboembolism is a common complication of acute lymphoblastic leukemia (ALL).

Cerebral sinus venous thrombosis (CSVT) is a type of venous thromboembolism (VTE). There are
many risk factors related to this condition including blood malignancy (most commonly acute
lymphoblastic leukemia and non-Hodgkin lymphoma), as much as treatments related to cancers,
including chemotherapy.

Objective: To report one case of cerebral sinus venous thrombosis (SCVT) in acute lymphoblastic
leukemia in Dr. Sardjito General Hospital, Yogyakarta

Case: A 5-year old girl came to Dr. Sardjito hospital with fever and diarrhea. The patient has ALL and
had been receiving ALL-2016 protocol (maintenance phase). During hospital stay, the patient had
repeated seizures, starting with focal seizure followed by general tonic clonic seizure and loss of
consciousness. Neurological status examination showed there were no meningeal signs and no
increase of physiological reflexes. Head CT-scan showed cerebral atrophy and paraventricular
ischemia. MRA and MRV were also performed confirming thrombosis in left transverse sinus. CSF
analysis demonstrated no blast cell. Due to further loss of consciousness, the patient was admitted to
pediatric intensive care unit, and thrombolysis treatment using subcutaneous Enoxaparin 0.2 mL per
12 hours was started. The patient was seizure-free and showed improvement in consciousness.

Conclusion: Cerebral sinus venous thrombosis (CSVT) is one of complications of acute

lymphoblastic leukemia (ALL) that is still underdiagnosed because of the possibility of other
complication, such as meningeal leukemia, whose occurrence seems higher and more familiar in our
clinical experience. More studies are needed on this condition, especially regarding to the long-term
management and outcomes to improve the prognosis.