악성 혈액 질환에서의 뇌혈관 질환

Abstract

Background : Strokes associated with hematologic malignancies have been rarely studied. We conducted this study to evaluate the etiology, incidence and clinical manifestation of the stroke associated with hematologic malignancies. Methods : We retrospectively analyzed the patients with cerebrovascular disease who were admitted to our hematologic clinic between January 1994 and December 1998. Results : Strokes occurred in 49 patients out of 4536 patients (1.1%). The mean age of stroke onset was 40.3 years. Thirty-two patients were men. Thirty-four had intracranial hemorrhages (20 intraparenchymal and 14 extraparenchymal) and 15 had ischemic infarcts. The most common etiology of intracranial hemorrhage was coagulopathy. Lobar hemorrhages were frequent (13/20), as were embolic infarcts (11/15). Main clinical features of intracranial hemorrhage were drowsiness and headache while ischemic infarcts were frequently associated with paresis and seizures. Hemorrhagic strokes had poorer prognosis than ischemic strokes. Stroke incidence in hematologic disease combined with disseminated intravascular coagulation (DIC) was higher (34.8%) than DIC patients with nonhematologic diseases (9.1%). Low platelet count did not influence on the subtype (hemorrhagic vs. ischemic) of stroke. Conclusions : Cerebrovascular diseases are relatively common in patients with hematologic malignancies, and could be one of the major causes of death in these population. Among various etiologies, coagulopathy and embolism are the main mechanisms of cerebrovascular diseases in these patients. Korean Journal of Stroke 2000;2(1): 35~39