Cefalea da emorragia intraparenchimale in una giovane paziente con primo riscontro di leucemia linfatica acuta in crisi

Headache is one of the most common reasons of emergency department admissions. This symptom can be caused by many pathologies as it is reported by “The International Classification of Headache Disorders”. Intraparenchymal haemorrhage caused by hyperleukocytosis is one of the worsen situation that an emergency physician can face. It records a mortality rate of 20%-40%. Hyperleukocytosis is defined as the presence of more than 100.000 white blood cells per mm3. Hyperleukocytosis can lead leukostasis. Leukostasis is defined as the pathological presence of leukemic blast cells in pulmonary or cerebral parenchyma. This can lead to respiratory failure and intraparenchymal haemorrhage. Leukostasis can be found more often during acute myeloid leukaemia than during acute lymphoid leukaemia and rarely occurs with less than 400.000 white blood cells per mm3. Clinical manifestations of leukostasis can be related with endothelial damage caused by leukemic blasts. Hypoxia, mental status disorders, headache, ataxia and fever are the most frequent symptoms of leukostasis. Disseminated intravascular coagulation and thrombocytopenia can also be found. We want to present a clinical report of what happened in our emergency department to a 19 years old young lady presenting herself to the hospital for headache unresponsive to non steroidal anti inflammatory drugs. We admitted the patient and noticed anisocoria, visual impairment, low psychomotor performance and headache.