{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,19]],"date-time":"2025-10-19T15:38:20Z","timestamp":1760888300937},"reference-count":19,"publisher":"BMJ","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Archives of Disease in Childhood"],"published-print":{"date-parts":[[1976,1,1]]},"DOI":"10.1136\/adc.51.1.74","type":"journal-article","created":{"date-parts":[[2008,12,22]],"date-time":"2008-12-22T21:14:24Z","timestamp":1229980464000},"page":"74-77","source":"Crossref","is-referenced-by-count":2,"title":["Multiple major cerebral artery thromboses with profound thrombocytopenia in acute leukaemia."],"prefix":"10.1136","volume":"51","author":[{"given":"D G","family":"Sims","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"D J","family":"Scott","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"T C","family":"Noble","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"513","DOI":"10.1136\/bmj.4.5734.513","article-title":"Combination chemotherapy using L-asparaginase, daunorubicin and cytosine arabinoside in adults with acute myelogenous leukaemia","volume":"4","author":"Crowther, D.; Bateman, C.J.T.; Vartan, C.P.; Whitehouse, J.M.A.; Malpas, J.S.; Fairley, G.H.; Scott, R.B.","year":"1970","unstructured":"Crowther, D., Bateman, C. J. T., Vartan, C. P., Whitehouse, J. M. A., Malpas, J. S., Fairley, G. H., and Scott, R. B. (1970). Combination chemotherapy using L-asparaginase, daunorubicin and cytosine arabinoside in adults with acute myelogenous leukaemia. British Medical Journal, 4, 513.","journal-title":"British Medical Journal"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1019","DOI":"10.1002\/1097-0142(196905)23:5<1019::AID-CNCR2820230506>3.0.CO;2-N","article-title":"Treatment of adult acute leukaemia with arabinosylcytosine and thioguanine","volume":"23","author":"Gee, T.S.; Yu, K.-P.; Clarkson, B.D.","year":"1969","unstructured":"Gee, T. S., Yu, K-P., and Clarkson, B. D. (1969). Treatment of adult acute leukaemia with arabinosylcytosine and thioguanine Cancer, 23, 1019.","journal-title":"Cancer"},{"key":"ref_3","first-page":"373","article-title":"Report of the Medical Research Council's Working Party on Leukaemia in Adults (1974). Treatment of acute myeloid leukaemia with daunorubicin, cytosine arabinoside, mercaptopurine, L-asparaginase, prednisone and thioguanine: results oftreatment with five multiple-drug schedules","volume":"27","unstructured":"Report of the Medical Research Council's Working Party on Leukaemia in Adults (1974). Treatment of acute myeloid leukaemia with daunorubicin, cytosine arabinoside, mercaptopurine, L-asparaginase, prednisone and thioguanine: results oftreatment with five multiple-drug schedules. BritishJournal of Haematology, 27, 373.","journal-title":"BritishJournal of Haematology"},{"key":"ref_4","article-title":"and antibiotic therapy in leukaemia are associated with an increase in fungal infections (Bodey, 1966). Having to deal with the clinical problems of thrombocytopenia and bleeding in leukaemia is not uncommon. In this situation it is very unusual to find at necropsy extensive antemortem thrombosis in the cerebral arterial circulation","author":"Cytotoxic, corticosteroid","unstructured":"Cytotoxic, corticosteroid, and antibiotic therapy in leukaemia are associated with an increase in fungal infections (Bodey, 1966). Having to deal with the clinical problems of thrombocytopenia and bleeding in leukaemia is not uncommon. In this situation it is very unusual to find at necropsy extensive antemortem thrombosis in the cerebral arterial circulation."},{"key":"ref_5","article-title":"She was readmitted during the 12th week with fever, respiratory distress, widespread purpura, and rectal bleeding. She was anaemic (Hb 5 g\/dl), leucopenic (total white blood count 2000\/mm3) and thrombocytopenic (platelets 20 000\/mm3). A blood culture grew meningococci. The bone marrow was hypoplastic. All cytotoxic therapy was stopped and she was given penicillin, sulphadimidine, and prednisone. While in this thrombocytopenic state she fell out of bed and developed a large frontal haematoma, the blood later gravitating down to surround both eyes. The skin overlying the haematoma and at the inner canthus of each eye sloughed. leaving deep ulcers. Swabs from the sloughed areas grew Esch. coli and Klebsiella aerogenes, but fungi were not specifically sought","unstructured":"She was readmitted during the 12th week with fever, respiratory distress, widespread purpura, and rectal bleeding. She was anaemic (Hb 5 g\/dl), leucopenic (total white blood count 2000\/mm3) and thrombocytopenic (platelets 20 000\/mm3). A blood culture grew meningococci. The bone marrow was hypoplastic. All cytotoxic therapy was stopped and she was given penicillin, sulphadimidine, and prednisone. While in this thrombocytopenic state she fell out of bed and developed a large frontal haematoma, the blood later gravitating down to surround both eyes. The skin overlying the haematoma and at the inner canthus of each eye sloughed. leaving deep ulcers. Swabs from the sloughed areas grew Esch. coli and Klebsiella aerogenes, but fungi were not specifically sought."},{"key":"ref_6","article-title":"Mucormycosis accounted for 2 of 16 cases of childhood cerebral arterial occlusion in a series reported in 1961","volume-title":"from where most descriptions of this disease have originated (Banker, 1961). The fungus infiltrates blood vessels and causes thrombotic occlusion, even in the presence of severe thrombocytopenia. This has rarely been reported in a child before (Hutter, 1959). In our patient, who had suffered severe bleeding in life, the finding of extensive arterial thrombosis came as a surprise","author":"the U. S. A","unstructured":"Mucormycosis accounted for 2 of 16 cases of childhood cerebral arterial occlusion in a series reported in 1961 from the U.S.A. from where most descriptions of this disease have originated (Banker, 1961). The fungus infiltrates blood vessels and causes thrombotic occlusion, even in the presence of severe thrombocytopenia. This has rarely been reported in a child before (Hutter, 1959). In our patient, who had suffered severe bleeding in life, the finding of extensive arterial thrombosis came as a surprise."},{"key":"ref_7","article-title":"Mucor occurs commonly in soil and decaying vegetable material. It can infect diabetics (Sandler et al., 1971), those with maligant disease, and occasionally otherwise healthy children","volume-title":"Its usual route of entry is via the paranasal sinuses and any suspect black sloughing lesion near the orbit or nose should be promptly biopsied as culture is difficult and unreliable","author":"Blodi, Hannah; Wadsworth, 1969","year":"1969","unstructured":"Mucor occurs commonly in soil and decaying vegetable material. It can infect diabetics (Sandler et al., 1971), those with maligant disease, and occasionally otherwise healthy children (Blodi, Hannah, and Wadsworth, 1969). Its usual route of entry is via the paranasal sinuses and any suspect black sloughing lesion near the orbit or nose should be promptly biopsied as culture is difficult and unreliable (Hart, Russell, and Remington. 1969). The branching nonseptate hyphae are readily distinguishable from Penicillium and Aspergillus (Fetter, Klintworth, and Hendry, 1967)."},{"key":"ref_8","article-title":"A standard combination of antibiotics for leukaemia patients with leucopenia and fever has been suggested by Tattersall, Spiers, and Darrell","volume-title":"They recommend adding amphotericin B if there has been no improvement in 48 hours. In the present case cerebral arterial occlusion had probably already started when the temperature rose a week before death. We can find no record of a leukaemic child with mucormycosis who survived","year":"1972","unstructured":"A standard combination of antibiotics for leukaemia patients with leucopenia and fever has been suggested by Tattersall, Spiers, and Darrell (1972). They recommend adding amphotericin B if there has been no improvement in 48 hours. In the present case cerebral arterial occlusion had probably already started when the temperature rose a week before death. We can find no record of a leukaemic child with mucormycosis who survived."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"127","DOI":"10.1097\/00005072-196101000-00008","article-title":"Cerebral vascular disease in infancy and childhood","volume":"20","author":"Banker, B.Q.","year":"1961","unstructured":"Banker, B. Q. (1961). Cerebral vascular disease in infancy and childhood. Journal of Neuropathology and Experimental Neurology, 20, 127.","journal-title":"Journal of Neuropathology and Experimental Neurology"},{"key":"ref_10","first-page":"698","article-title":"Lethal orbitocerebral phycomycosis in otherwise healthy children","volume":"67","author":"Blodi, F.C.; Hannah, F.T.; Wadsworth, J.A.C.","year":"1969","unstructured":"Blodi, F. C., Hannah, F. T., and Wadsworth, J. A. C. (1969). Lethal orbitocerebral phycomycosis in otherwise healthy children. American Journal of Ophthalmology, 67, 698.","journal-title":"American Journal of Ophthalmology"},{"key":"ref_11","first-page":"667","article-title":"Fungal infections complicating acute leukemia. J, ournal of Chronic","volume":"19","author":"Bodey, G.P.","year":"1966","unstructured":"Bodey, G. P. (1966). Fungal infections complicating acute leukemia. J,ournal of Chronic Diseases, 19, 667.","journal-title":"Diseases"},{"key":"ref_12","author":"Fetter, B.F.; Klintworth, G.K.; Hendry, W.S.","year":"1967","unstructured":"Fetter, B. F., Klintworth, G. K., and Hendry, W. S. (1967)."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"169","DOI":"10.1093\/infdis\/120.2.169","article-title":"The compromised host and infection. II. Deep fungal infection","volume":"120","author":"Hart, P.D.; Russell, E.; Remington, J.S.","year":"1969","unstructured":"Hart, P. D., Russell, E., and Remington, J. S. (1969). The compromised host and infection. II. Deep fungal infection. Journal of Infectious Disease, 120, 169.","journal-title":"Journal of Infectious Disease"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"330","DOI":"10.1002\/1097-0142(195903\/04)12:2<330::AID-CNCR2820120217>3.0.CO;2-F","article-title":"Phycomycetous infection (mucormycosis) in cancer patients:-a complication of therapy","volume":"12","author":"Hutter, R.V.P.","year":"1959","unstructured":"Hutter, R. V. P. (1959). Phycomycetous infection (mucormycosis) in cancer patients:-a complication of therapy. Cancer, 12, 330.","journal-title":"Cancer"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1180","DOI":"10.1056\/NEJM197111182852107","article-title":"Successfully treated rhinocerebral phycomycoses in well controlled diabetes","volume":"285","author":"Sandler, R.; Tallman, C.B.; Keamy, D.G.; Irving, W.R.","year":"1971","unstructured":"Sandler, R., Tallman, C. B., Keamy, D. G., and Irving, W. R. (1971). Successfully treated rhinocerebral phycomycoses in well controlled diabetes. New England Journal of Medicine, 285, 1180.","journal-title":"New England Journal of Medicine"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"162","DOI":"10.1016\/S0140-6736(72)90567-3","article-title":"Initial therapy with combination of five antibiotics in febrile patients with leukaemia and neutropoenia","volume":"1","author":"Tattersall, M.H.; Spiers, A.S.; Darrell, J.H.","year":"1972","unstructured":"Tattersall, M. H., Spiers, A. S., and Darrell, J. H. (1972). Initial therapy with combination of five antibiotics in febrile patients with leukaemia and neutropoenia. Lancet, 1, 162.","journal-title":"Lancet"},{"key":"ref_17","article-title":"Some factors implicated in causing hypsarrhythmia have included cerebral birth injury, toxoplasmosis, postnatal head injury, meningitis, encephalitis, tuberous sclerosis, phenylketonuria, pyridoxine deficiency (Millichap","volume":"1962","author":"and infection with cytomegalovirus (Stern, Latham, and Tizard","unstructured":"Some factors implicated in causing hypsarrhythmia have included cerebral birth injury, toxoplasmosis, postnatal head injury, meningitis, encephalitis, tuberous sclerosis, phenylketonuria, pyridoxine deficiency (Millichap et al., 1962), and infection with cytomegalovirus (Stern, Latham, and Tizard","journal-title":"et al"},{"key":"ref_18","article-title":"To our knowledge congenital rubella infection has never been implicated as a contributing factor","unstructured":"). To our knowledge congenital rubella infection has never been implicated as a contributing factor."},{"key":"ref_19","article-title":"Monthly assessments since birth showed that development was normal up to the onset of hypsarrhythmia. Development then began to lag. By 10 months he was functioning at a 5-month level using the Stycar tests (Sheridan, 1968). A review at 25 months showed normal hearing and no evidence of cataracts or retinopathy. A Griffiths assessment (Griffiths, 1954) showed","volume-title":"Delays were most marked in language development (9-month level) and hand-eye co-ordination","author":"delay in all areas","unstructured":"Monthly assessments since birth showed that development was normal up to the onset of hypsarrhythmia. Development then began to lag. By 10 months he was functioning at a 5-month level using the Stycar tests (Sheridan, 1968). A review at 25 months showed normal hearing and no evidence of cataracts or retinopathy. A Griffiths assessment (Griffiths, 1954) showed delay in all areas. Delays were most marked in language development (9-month level) and hand-eye co-ordination (12-month level)."}],"container-title":["Archives of Disease in Childhood"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/adc.51.1.74","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2020,9,26]],"date-time":"2020-09-26T09:05:41Z","timestamp":1601111141000},"score":1,"resource":{"primary":{"URL":"https:\/\/adc.bmj.com\/lookup\/doi\/10.1136\/adc.51.1.74"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[1976,1,1]]},"references-count":19,"journal-issue":{"issue":"1","published-print":{"date-parts":[[1976,1,1]]}},"URL":"https:\/\/doi.org\/10.1136\/adc.51.1.74","relation":{},"ISSN":["0003-9888","1468-2044"],"issn-type":[{"value":"0003-9888","type":"print"},{"value":"1468-2044","type":"electronic"}],"subject":[],"published":{"date-parts":[[1976,1,1]]}}}