Hemorrhagic Cerebral Vascular Accident with Breakdown of Salt-Wasting Cerebral Syndrome in Acute Lymphoblastic Leukemia: Case Report

Introduction:Cerebral Salt Losing Syndrome (SCLS) is defined as a renal loss of sodium during intracranial disease, leading to hyponatremia and decreased volume of extravascular fluid. Studies show the existence of an association with hemorrhagic stroke (HCV) and SCLS as a complication that significantly contributes to the morbidity and mortality of patients with acute lymphoid leukemia (ALL).Objective:To report a case of a patient with ALL who presented HCV with neurological lesion, showing repercussions in the nervous system through SCPS.Case Description:A 33-year-old female patient was referred to the specialized hematology service, complaining of petechiae spread in the trunk and limbs, high fever, progressive asthenia, generalized pain in addition to nausea and vomiting. Laboratory data showed pancytopenia and IgM and IgG serology reagent for dengue. Cytomorphological examination of peripheral blood showed the presence of 68% of lymphoid blast cells, later confirming by bone marrow aspirate immunophenotyping as a CD10 negative pre-B ALL (pro-B ALL). After the start of chemotherapy treatment, the patient presented episodes of generalized tonic-clonic seizure crisis that were repeated in the two days that followed, in addition to referring to intense paresthesia in the upper limbs and headache and referred to the Intensive Care Unit (ICU). Imaging exams showed heterogeneous right frontal hemorrhage compatible with HCV, and sagittal sinus thrombosis, with an increase in frontal hematoma with deviation of centro medial structures. Subsequently, he presented high urinary output (6,500 mL / 24 hours) with severe polydipsia, in addition to hyponatremia (129), hypouricemia (20) and decreased creatinine (0.3), urinary sodium concentration and urinary osmolarity, evolving with dehydration (+++ / 4+) and hemodynamic instability, establishing the diagnosis of SCPS. After intervention with flourcortisone and hydroelectrolytic replacement, the patient presented an improvement in the condition of SCLS and, with significant clinical improvement, the patient continues on specific cancer treatment, and without neurological sequelae.Conclusion:The correct clinical and laboratory diagnosis allows an early and safe intervention. Knowledge of this clinical entity enables specific treatment and a favorable outcome for the patient.