Bilateral Subacute Subdural Hematoma as a Complication of T-Cell Acute Lymphoblastic Leukemia/Lymphoma: A Case Report

Abstract

Subdural hematoma (SDH) is a rare but serious complication of hematologic malignancy. We report a 69-year-old male patient with newly diagnosed T-cell acute lymphoblastic leukemia/lymphoma who developed bilateral subacute SDH presenting with sudden severe headache approximately five months after diagnosis, during induction chemotherapy. Throughout the course of the disease, the platelet count and routine coagulation tests, including fibrinogen, remained normal. Baseline neuroimaging obtained three years prior to diagnosis had already shown generalized cerebral atrophy and lacunar infarctions, indicating pre-existing structural vulnerability rather than treatment-induced changes. During induction, the patient underwent repeated lumbar punctures and intrathecal chemotherapy for central nervous system prophylaxis, which may have imposed additional mechanical and cerebrospinal fluid pressure stress on the already atrophied brain. The patient also had atypical cells in the cerebrospinal fluid (CSF), raising the possibility of leukemia-associated central nervous system (CNS) microvasculopathy as an additional, previously under-recognized contributing factor. Bilateral burr-hole drainage achieved good decompression and allowed the patient to resume chemotherapy, although the leukemia subsequently progressed. This case suggests that for patients with a history of cerebral atrophy undergoing repeated intraspinal procedures, heightened vigilance for this complication is warranted, rather than attributing the bleeding risk primarily to a single coagulation abnormality.