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J Neurocrit Care 2010;3(2): 38-41.
급성전골수성백혈병 환자에서 All-Trans Retinoic Acid 증후군의 일환으로 발생한 양측성 전대뇌동맥 부위 경색
김 동 건·오 승 헌
차의과학대학교 신경과학교실
Bilateral Anterior Cerebral Artery-Territory Infarction as a Manifestation of All-Trans Retinoic Acid Syndrome in a Patient with Acute Promyelocytic Leukemia
Dong-Gun Kim, MD and Seung-Hun Oh, MD
Department of Neuroloy, CHA University School of Medicine, Seongnam, Korea
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.
Key Words: Acute promyelocytic leukemia · All-trans retinoic acid syndrome · Cerebral infarction
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