Abstract: Objective To investigate the clinical characteristics, imaging features, laboratory test results, and prognosis of children with acute lymphoblast leukemia (ALL) complicated by cerebral hemorrhage. Methods A retrospective analysis was conducted on the clinical data of 20 children with ALL complicated by cerebral hemorrhage admitted to the Department of Hematology, Children's Hospital of Soochow University from June 20, 2014 to June 20, 2024. Results The clinical manifestation of the 20 children with ALL complicated by cerebral hemorrhage were complex and diverse, with disturbance of consciousness being the most common initial symptom. The prognosis varied depending on the size and location of the hematoma and whether it ruptured into the ventricle. Among the 20 cases, 14(70%) demonstrated improvement in intracranial lesions, with 8(40%) cases exhibiting substantial lesion absorption and favorable prognosis. Six cases(30%) showed improvement in intracranial lesions but not complete resolution, three cases developed focal encephalomalacia, two cases had residual symptomatic epilepsy and one had residual right-sided hemiplegia. Furthermore, three(15%) cases suffered recurrent cerebral hemorrhages at distinct locations from the initial event following improvement of the primary hemorrhage, and 3(15%) cases led to mortality. Conclusions Neurological symptoms in children with acute lymphoblast leukemia (ALL) complicated by cerebral hemorrhage are diverse and often atypical. Timely cranial imaging and laboratory tests are necessary, while surgical intervention and platelet transfusion should be a prudential consideration.

Key words: acute lymphoblast leukemia, cerebral hemorrhage, children, clinical analysis, prognosis