Hemorrhagic syndrome represents a life-threatening complication in acute lymphoblastic leukemia (ALL), particularly when accompanied by central nervous system (CNS) involvement. Intracranial hemorrhage (ICH) in ALL arises from thrombocytopenia, hyperleukocytosis-induced leukostasis, coagulopathy, and direct leukemic infiltration of cerebral vessels. Although magnetic resonance imaging (MRI) and computed tomography (CT) are essential for diagnosis, early recognition remains challenging, and outcomes are frequently fatal. This study evaluated clinical, laboratory, and neuroimaging characteristics in 12 patients with newly diagnosed or relapsed ALL presenting with severe hemorrhagic syndrome and confirmed CNS involvement. All patients exhibited profound thrombocytopenia and/or hyperleukocytosis at onset. Intraparenchymal hemorrhage was the predominant pattern (75%), with multifocal lesions in 58% of cases. Despite aggressive supportive care (platelet transfusions, fresh frozen plasma, and emergency chemotherapy), case fatality reached 67% within 30 days. Survivors showed partial neurological recovery but required intensive rehabilitation. These findings underscore the need for rapid cytoreduction, prophylactic platelet support, and routine neuroimaging in high-risk ALL patients with suspected CNS involvement. Larger multicenter studies are warranted to establish standardized management protocols and improve survival in this high-mortality subgroup.

acute lymphoblastic leukemia, intracranial hemorrhage, hemorrhagic syndrome, central nervous system involvement, hyperleukocytosis, thrombocytopenia, leukostasis.

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