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KMID : 1201420100030020038
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Journal of Neurocritical Care
2010 Volume.3 No. 2 p.38 ~ p.41
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Bilateral Anterior Cerebral Artery-Territory Infarction as a Manifestation of All-Trans Retinoic Acid Syndrome in a Patient with Acute Promyelocytic Leukemia
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Kim Dong-Gun
Oh Seung-Hun
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Abstract
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Background: All-trans retinoic acid (ATRA) syndrome is an adverse reaction of ATRA therapy for acute promyelocytic leukemia (APL). Although microthrombosis of lung or kidney is the main pathogenesis, arterial occlusion of large diameter in central nervous system is uncommon.
Case Report: A 32 year old woman with APL presented generalized edema, pneumonia, pulmonary edema, and pericardial effusion 3days after ATRA therapy. During disease course, bilateral limbs weakness developed, and brain imaging study revealed cerebral infarct caused by bilateral anterior cerebral artery occlusion. Discontinuation of ATRA and conservative management resulted in complete recovery of systemic manifestation but residual neurological deficits remained.
Conclusions: Although systemic manifestations of ATRA syndrome are usually reversible, permanent neurological deficits may develop in rare case with cerebral arterial occlusion. Therefore, preventive treatment of cerebral arterial complication should be taken into account, especially in cases with high white blood cell count.
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KEYWORD
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Acute promyelocytic leukemia, All-trans retinoic acid syndrome, Cerebral infarction
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