Headache and Subdural Hematoma as Initial Presentation of Chronic Myeloid Leukemia: A Case Report

以頭痛與硬腦膜下血腫為初始表現的慢性骨髓性白血病：病例報告

林金生(Chin-Shen Lin) ； 郭芳里(Fang-Li Kuo) ； 劉冠廷(Kuan-Ting Liu)

《南臺灣醫學雜誌》 17卷1期 (2021/06) Pp. 50-53

https://doi.org/10.6726/MJST.202106_17(1).0006

摘要

Subdural hematoma results from intracranial hemorrhage and blood accumulation between the inner layer of the dura mater and arachnoid mater. The causes include traumatic head injury and a variety of non-traumatic conditions. Spontaneous subdural hematoma is a rare complication of chronic myeloid leukemia. A case of 21- year-old man with no previous systemic disease who visited our emergency department with periorbital pain, mild headache, nausea, and vomiting for 2-3 days. Conscious change with drooling and upward eye gaze occurred a few hours later as the patient remained in the emergency department. Laboratory data showed a white blood cell count of 197,000/μL (promyelocytes, 0.5%; myelocytes, 9%; metamyelocytes, 7%; monocytes, 0.5%; lymphocytes, 2%). Brain computed tomography revealed a left parietal lobe acute subdural hemorrhage. Emergent craniectomy was performed. Tissue pathology confirmed chronic myeloid leukemia with brain metastasis. As spontaneous subdural hematoma is a complication of chronic myeloid leukemia, patients with hematological diseases and headache may need prompt examination via computed tomography.

關鍵字

spontaneous subdural hematoma

並列摘要

硬腦膜下血腫主要是由於顱內出血使得血液累積在硬腦膜內層與蜘蛛膜間，造成的原因包括外傷性腦損傷與各種非外傷性的因素。硬腦膜下血腫是慢性骨髓性白血病罕見的併發症，在此我們報告了一位21歲男性，過去無任何病史，來急診主訴眼眶周圍疼痛、輕微頭痛、嘔心嘔吐2～3天，在急診等待住院過程中，突然意識喪失合併流口水、雙眼上吊，血液報告顯示白血球19萬7千（前髓細胞0.5％；髓細胞9％；中髓細胞7％；單核球0.5％；淋巴球2％）。腦部電腦斷層顯示左側頂葉急性硬腦膜下出血，緊急施行開腦手術，組織病理學證實是慢性骨髓性白血病合併腦部轉移。自發性硬腦膜下出血是慢性骨髓性白血病的罕見併發症，因此當一位血液疾病患者合併頭痛時，也許腦部電腦斷層檢查是必須要的考量。

並列關鍵字

自發性硬腦膜下血腫