背景:骨髓增生异常综合征(MDS)和急性髓性白血病(AML)由于其不同的临床表现和血栓性并发症而提出了复杂的挑战。新诊断的AML患者的血栓栓塞(TE)发生率值得注意,动脉TE与较差的总体生存率有关。缺血性中风,尽管患病率相对较低,具有重要的临床意义。
方法:我们报告一例84岁男性2型糖尿病,高血压,慢性肾脏病,出现癫痫发作,局灶性神经功能缺损,和全血细胞减少症.在调查期间出现了AML或MDS的意外诊断。尽管采取了干预措施,病人的病情恶化,几周后导致致命的结果。
结论:该病例强调了恶性血液病与缺血性卒中之间的复杂关系。这种复杂性的罕见性强调了理解发挥作用的多方面机制的重要性,包括高白细胞增多,促炎细胞因子释放,凝血级联激活,与内皮细胞的直接相互作用。在我们的文献综述中,15例分析,包括我们的,显示出广泛的年龄范围(3-87岁)和对女性的性别偏见。AML诊断占优势,具有均匀低的血小板计数。皮质梗塞,尤其是在前循环中,很常见。白细胞增多症,弥散性血管内凝血(DIC),在部分病例中观察到致死性结局.尽管统计数据严峻,预后通常较差,识别特定的风险因素,如血小板减少症和细胞遗传学异常,为有针对性的预防和管理提供了途径。
BACKGROUND: Myelodysplastic syndromes (MDS) and acute myeloid leukemia (AML) present intricate challenges due to their diverse clinical manifestations and thrombotic complications. Thromboembolism (TE) incidence in newly diagnosed AML patients is noteworthy, with arterial TE linked to poorer overall survival. Ischemic strokes, although relatively low in prevalence, carry significant clinical implications.
METHODS: We report the case of an 84-year-old male with Type 2 Diabetes, Hypertension, and Chronic Kidney Disease, presenting with seizures, focal neurological deficits, and pancytopenia. An unexpected diagnosis of AML or MDS emerged during the investigation. Despite interventions, the patient\'s condition deteriorated, leading to a fatal outcome weeks later.
CONCLUSIONS: This case underscores the intricate relationship between hematologic malignancies and ischemic stroke. The rarity of this complication emphasizes the importance of understanding the multifaceted mechanisms at play, including hyperleukocytosis, pro-inflammatory cytokine release, coagulation cascade activation, and direct interactions with endothelial cells. In our literature review, analysis of 15 cases, including ours, revealed a wide age range (3-87 years) and a gender bias towards females. AML diagnosis was predominant, with uniformly low platelet counts. Cortical infarctions, especially in the anterior circulation, were common. Hyperleukocytosis, disseminated intravascular coagulation (DIC), and fatal outcomes were observed in a subset of cases. Despite the grim statistics and often poor prognosis, the identification of specific risk factors, such as thrombocytopenia and cytogenetic abnormalities, offers avenues for targeted prevention and management.