Migraine due to intraparenchymal hemorrhage during a blast crisis

Background. Hyperleukocytosis is defined as a white blood cell (WBC) count in excess of 100,000 per mm3. Hyperleuko-cytosis can cause leukostasis syndrome, the accumulation of leukemic blast cells within the capillary lumen, resulting in neurologic and pulmonary manifestations that can lead to intracranial haemorrhage and respiratory failure.

Objective. Identify a correct diagnostic approach, as the diagnosis of leukostasis in a patient suffering from acute leuke-mia with hyperleukocytosis is made only clinically. A full blood cell count and a peripheral blood smear are essential for diagnosing leukostasis.

Case report. A 19 year old girl presented to the emergency department reporting onset of headache, absence of regression of symptoms after taking painkillers (non steroidal anti inflammatory drugs (NSAIDs)), intense fatigue and absence of fever. On examination, modest hypotension and anisocoria (with reactive pupils) were evidenced. A brain computed tomography (CT) scan was performed. Several, large areas of parenchymal haemorrhage were identified. A chest and abdomen CT scan was requested. The images demonstrated the presence of splenomegaly. The laboratory findings confirmed the suspected diagnosis, with a leukocyte count equal to 980,000 units per mm3 and a platelet count of 24,000 units per mm3. Conclusion. Given the clinical case and its evolution, no report of recent onset of headache, especially in young patients, should be underestimated.

intraparenchymal hemorrhage, hyperleukocytosis, leukostasis, leukaemia, emergency department

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