ABSTRACT
BACKGROUND: Dasatinib, a tyrosine kinase inhibitor commonly used in treatment of acute lymphoblastic leukemia and chronic myelogenous leukemia, is often associated with hemorrhagic complications. Safety of dasatinib after thrombolytic therapy in acute ischemic stroke is unknown. CASE DESCRIPTION: A 63-year-old man with multiple vascular risk factors and chronic myelogenous leukemia (in molecular remission) on dasatinib presented with signs and symptoms of right hemispheric stroke owing to acute intracranial internal carotid artery occlusion that was treated with intravenous thrombolysis and mechanical thrombectomy resulting in near-complete resolution of stroke symptoms. The patient developed clinical worsening (>24 hours of thrombolytic therapy) after receiving a second dose of dasatinib that was due to symptomatic intracerebral hemorrhage and necessitated decompressive hemicraniectomy. Routine coagulation profile was normal. The etiology of this hemorrhagic complication was likely secondary to primary platelet dysfunction due to dasatinib as reported in some recent in vitro and ex vivo studies. CONCLUSIONS: It is advisable to withhold dasatinib during the poststroke period owing to its associated risk of symptomatic intracerebral hemorrhage.
Subject(s)
Antineoplastic Agents/adverse effects , Cerebral Hemorrhage/chemically induced , Dasatinib/adverse effects , Brain Ischemia/therapy , Carotid Artery Thrombosis/therapy , Carotid Artery, Internal , Fibrinolytic Agents/therapeutic use , Humans , Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy , Male , Mechanical Thrombolysis/methods , Middle Aged , Stroke/therapy , Tissue Plasminogen Activator/therapeutic useABSTRACT
Synovial sarcoma is a soft-tissue sarcoma. Its involvement of the spine is extremely rare. We report a 40 year old male who presented with shoulder pain and progressive weakness in all four limbs for six months with a visible, slowly growing bulge in his upper back. On examination he had quadriparesis and diffuse sensory deficit. MRI of the cervical spine showed a large soft tissue mass, iso to hypointense, extending into the neural canal, compressing the cord. The mass had a few internal areas of contrast enhancement with extension into the right paraspinal regions involving the vertebral bodies. Sub-periosteal spine dissection was done. Tumour was primarily extradural, involving and extending from paraspinal soft tissues to the posterior arches, laminae and spinous processes of the verteberae, with their destruction. Gross radical removal of the visible mass was done, followed by three cycles of radiation therapy. Excisional biopsy showed synovial sarcoma TYPE II. In conclusion, synovial sarcomas should be kept in the differentials of a mass arising in spinal axis.
