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Posterior Reversible Encephalopathy Syndrome on 18F-FDG PET/CT in a Pediatric Patient With Burkitt's Lymphoma. Clin Nucl Med 2018; 43:195-198. [PMID: 29356747 DOI: 10.1097/rlu.0000000000001979] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
We present a case of posterior reversible encephalopathy syndrome (PRES) in a pediatric patient with Burkitt's lymphoma predominantly involving the bone marrow. F-FDG PET/CT scan obtained after the first cycle of chemotherapy, complicated by acute kidney injury, hypertension, tumor lysis syndrome, and lethargy with focal neurological symptoms, showed a favorable marrow and lymph node response but increased FDG uptake in the bilateral frontal and occipital cortical/subcortical regions. Brain MRI was consistent with PRES. The patient was managed with IV hydration and blood pressure control with symptom resolution. This case shows the F-FDG uptake pattern of PRES in postchemotherapy setting.
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Mescher C, Slungaard A. Posterior reversible encephalopathy syndrome in a postpartum woman with acute lymphoblastic leukaemia after intrathecal methotrexate. BMJ Case Rep 2017; 2017:bcr-2017-220429. [PMID: 28978582 DOI: 10.1136/bcr-2017-220429] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Posterior reversible encephalopathy syndrome (PRES) is the most common neurological complication occurring in children undergoing induction chemotherapy for acute lymphoblastic leukaemia (ALL) but is increasingly recognised to occur in adults as well. Here, we report a woman who presented with B-cell ALL (B-ALL) at the time of delivery and developed PRES 1 day after receiving intrathecal (IT) methotrexate (MTX) that rapidly resolved. She subsequently received IT MTX without recurrence of neurological symptoms. This case represents the first case of PRES in a postpartum B-ALL patient receiving IT MTX, demonstrates that re-treatment with MTX in this case could be done safely and highlights the risk of PRES in adults treated for B-ALL.
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Affiliation(s)
- Craig Mescher
- Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| | - Arne Slungaard
- Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA
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Zhang R, Jin L, Cheng H, Yang J, Duan YL, Huang S, Zhang YH. Reversible Posterior Leukoencephalopathy Syndrome Sometimes Could be Irreversible: A Case Following Tumor Lysis Syndrome in Childhood Burkitt's Lymphoma. Chin Med J (Engl) 2017; 129:480-3. [PMID: 26879024 PMCID: PMC4800851 DOI: 10.4103/0366-6999.176075] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Affiliation(s)
| | | | | | | | | | | | - Yong-Hong Zhang
- Beijing Key Laboratory of Pediatric Hematology Oncology, National Key Discipline of Pediatrics, Ministry of Education, Hematology Oncology Center, Beijing Children's Hospital, Capital Medical University, Beijing 100045, China
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Li Y, Jenny D, Castaldo J. Posterior Reversible Encephalopathy Syndrome: Clinicoradiological Spectrum and Therapeutic Strategies. Hosp Pract (1995) 2015; 40:202-13. [PMID: 22406896 DOI: 10.3810/hp.2012.02.961] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Yuebing Li
- Physician, Division of Neurology, Department of Medicine, Lehigh Valley Health Network, Allentown, PA 18103, USA
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Marsh A, Agrawal AK, Feusner JH. Tumor Lysis Syndrome. SUPPORTIVE CARE IN PEDIATRIC ONCOLOGY 2015. [DOI: 10.1007/978-3-662-44317-0_3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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Suzuki D, Kobayashi R, Iguchi A, Sano H, Kishimoto K, Yasuda K, Kobayashi K. Tumor lysis syndrome as a risk factor for posterior reversible encephalopathy syndrome in children with hematological malignancies. Int J Hematol 2014; 100:485-9. [PMID: 25216697 DOI: 10.1007/s12185-014-1658-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Revised: 08/26/2014] [Accepted: 09/01/2014] [Indexed: 11/29/2022]
Abstract
Posterior reversible encephalopathy syndrome (PRES) is a neurological disorder characterized by seizures, altered mental status and visual disorders, along with characteristic radiological findings. It is strongly related to hypertension induced by steroids and other immunosuppressive agents. There are an increasing number of reports regarding PRES arising during the course of chemotherapy for hematological malignancies. To clarify the risk factors for this phenomenon, we retrospectively analyzed pediatric patients undergoing treatment for hematological malignancies. Of 161 patients, six patients (3.7%) developed PRES with characteristic clinical and radiographic findings. Univariate analysis revealed that tumor lysis syndrome (TLS) was a significant risk factor for the onset of PRES. TLS is a significant risk factor for the development of PRES in pediatric patients receiving chemotherapy for hematological malignancies.
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Affiliation(s)
- Daisuke Suzuki
- Department of Pediatrics, Sapporo Hokuyu Hospital, Higashi-Sapporo 6-6, Shiroishiku, Sapporo, 003-0006, Japan,
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Chandramohan V, Nagarajan VP, Sathyamoorthi MS, Kumar S, Shanmugasundaram C, Periakaruppan G, Scott JX. Posterior reversible encephalopathy syndrome in a child with autoimmune lymphoproliferative syndrome: Case report and review of literature. J Pediatr Neurosci 2013; 7:221-4. [PMID: 23560015 PMCID: PMC3611917 DOI: 10.4103/1817-1745.106486] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Posterior reversible encephalopathy syndrome (PRES) is characterized by headache, nausea, vomiting, seizures and visual disturbances. PRES has been usually associated with hypertension, chronic renal disease, malignancy and chemotherapeutic agents. We report the association of PRES with Autoimmune lymphoproliferative syndrome, which to our best knowledge has not been reported before.
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Firwana BM, Hasan R, Hasan N, Alahdab F, Alnahhas I, Hasan S, Varon J. Tumor lysis syndrome: a systematic review of case series and case reports. Postgrad Med 2012; 124:92-101. [PMID: 22437219 DOI: 10.3810/pgm.2012.03.2540] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Tumor lysis syndrome (TLS) is a clinical condition that is caused by a massive lysis of tumor cells that accumulate very rapidly and disturb hemodynamics. This oncologic emergency requires immediate intervention. Tumor lysis syndrome was first described in the 19th century. Since then, it has become a well-known disease with improved management measures. Tumor lysis syndrome can occur after any type of neoplasm. It is highly associated with rapidly proliferating tumors compared with those that are well demarcated, such as acute lymphoblastic leukemia and high-grade non-Hodgkin lymphoma. Initiation of chemotherapy, radiotherapy, or steroid treatment may trigger TLS, or it may develop spontaneously. The release of massive quantities of intracellular contents may produce hyperkalemia, hyperphosphatemia, secondary hypocalcemia, hyperuricemia, and acute renal failure. Prevention and treatment measures include intravenous hydration, use of allopurinol and rasburicase, management of TLS-associated electrolyte abnormalities, and renal replacement therapy; the use of urine alkalinization remains controversial. In this article, we summarize the findings of case series and case reports published over the past 6 years in an effort to help familiarize clinicians better recognize and manage TLS.
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Affiliation(s)
- Belal M Firwana
- Department of Internal Medicine, University of Missouri, Columbia, USA
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Abstract
Reversible posterior leucoencephalopathy syndrome is a neurological condition seen in various areas of acute medicine, including the administration of antineoplastic therapies used in haemato-oncology patients. It is a rare complication that has been increasingly recognized. It is characterized by altered mental status, visual disturbance, headache and seizures. Magnetic resonance imaging typically shows vasogenic oedema in the posterior regions of the brain. Although its name suggests reversibility, it may result in an irreversible brain injury without prompt treatment. Therefore, it is vital for treating clinicians to recognize this syndrome. We describe the case of a 55-year-old woman with advanced pancreatic adenocarcinoma, who developed clinical and radiological manifestations consistent with this syndrome as a complication of gemcitabine monotherapy.
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Affiliation(s)
- C H Han
- Department of Medical Oncology, Auckland City Hospital, Auckland, New Zealand
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de Laat P, Te Winkel ML, Devos AS, Catsman-Berrevoets CE, Pieters R, van den Heuvel-Eibrink MM. Posterior reversible encephalopathy syndrome in childhood cancer. Ann Oncol 2010; 22:472-8. [PMID: 20699277 DOI: 10.1093/annonc/mdq382] [Citation(s) in RCA: 79] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Posterior reversible encephalopathy syndrome (PRES) is characterized by seizures, headaches, altered mental status, cortical blindness and typical transient lesions on magnetic resonance imaging. PATIENTS AND METHODS We describe seven childhood cancer patients with clinical and radiological symptoms of PRES, and reviewed all well-documented PRES cases reported during childhood cancer treatment. RESULTS Fifty-six children with PRES, including our 7 cases, were identified in the literature. Mean age at onset was 9 (range: 2-17) years. Primary diagnoses were acute lymphoblastic leukemia (n = 31), acute myeloid leukemia (n = 5), non-Hodgkin lymphoma (n = 7) and solid tumors (n = 13). PRES patients presented with seizures (n = 50), altered mental status (n = 20), visual disturbances (n = 24) and/or headaches (n = 17). PRES was associated with hypertension in 49 patients. About 86% of the patients had both clinical and radiological reversible symptoms. Four patients developed epilepsy, in one patient ataxia remained and one patient had a persistent mydriasis. CONCLUSION Although PRES has predominantly been described in leukemia patients, it occurs in children with solid tumors as well. Hypertension seems to be the most important trigger for the occurrence of PRES during childhood cancer treatment. Seizures are the most common accompanying sign. Symptoms and radiological findings normalize in ∼90% of the cases, but in 10% neurological symptoms remain.
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Affiliation(s)
- P de Laat
- Department of Pediatric Oncology/Hematology, Erasmus MC-Sophia Children’s Hospital, University Medical Center, Rotterdam, The Netherlands
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Reversible posterior leukoencephalopathy syndrome. Transl Neurosci 2010. [DOI: 10.2478/v10134-010-0016-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
AbstractReversible posterior leukoencephalopathy syndrome (RPLS) is characterized by subacute onset of headache, decreased alertness, vomiting, seizures, visuoperceptual disturbances, together with bilateral white matter lesions in posterior brain regions on brain imaging. The most frequently associated conditions related to RPLS are arterial hypertension and the use of immunosuppressive or cytotoxic treatment. T2-, Fluid Attenuation Inversion Recovery (FLAIR), and Apparent Diffusion Coefficient (ADC)-weighted magnetic resonance imaging (MRI) reveal hyperintensities in parietooccipital white matter but grey matter and other regions including frontal and temporal lobes, brainstem, cerebellum, basal ganglia, or even spinal cord may also be involved. According to ADC findings, the underlying pathophysiologic mechanism is probably one of vasogenic (rather than cytotoxic) oedema. These MRI findings help in differentiating RPLS from ischaemic events and other diseases resembling RPLS. Failure of cerebral autoregulation, endothelial dysfunction, disrupted blood-brain barrier, vasospasm, and direct toxic drug effects may all play a role in the pathophysiology of RPLS. Treatment consists of discontinuation of the causal drug, treatment of high blood pressure, and antiepileptic therapy. Clinical recovery and regression of radiological abnormalities are typically seen after early treatment. However, delay in diagnosis and treatment can result in irreversible brain damage, often in association with complicating cerebral infarction or haemorrhage.
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Reversible posterior leukoencephalopathy syndrome in childhood: report of nine cases and review of the literature. Neurol Sci 2009; 31:125-31. [DOI: 10.1007/s10072-009-0158-z] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2009] [Accepted: 09/11/2009] [Indexed: 10/20/2022]
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Onujiogu N, Lengyel E, Yamada S. Reversible posterior leukoencephalopathy syndrome following intravenous paclitaxel and intraperitoneal cisplatin chemotherapy for fallopian tube cancer. Gynecol Oncol 2008; 111:537-9. [DOI: 10.1016/j.ygyno.2008.04.032] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2008] [Revised: 04/28/2008] [Accepted: 04/29/2008] [Indexed: 01/05/2023]
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Grewal J, Grewal HK, Forman AD. Seizures and epilepsy in cancer: etiologies, evaluation, and management. Curr Oncol Rep 2008; 10:63-71. [PMID: 18366962 DOI: 10.1007/s11912-008-0010-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Seizure and epilepsy are common neurologic issues in cancer patients. Etiologies include structural abnormalities of the brain (eg, brain metastasis), cerebrovascular disease, reversible posterior leukoencephalopathy syndrome (RPLS), and radiation toxicity. Seizures associated with these etiologies often have focal features. Metabolic causes include hypoglycemia, electrolyte abnormalities, tumor lysis syndrome, thrombotic thrombocytopenic purpura (TTP), and medications used in cancer. A careful clinical evaluation can suggest the seizure etiology and guide subsequent work-up. Nonconvulsive status epilepticus should be suspected with persistent decreased level of consciousness following a seizure. Certain etiologies, such as RPLS and TTP, must be treated aggressively to minimize permanent neurologic injury. Routine prophylaxis with antiepileptic drugs (AEDs) is not recommended in patients with primary brain tumors or brain metastasis who have never had a seizure. Where indicated, the selection of AEDs should take into consideration side effects and interactions with chemotherapy. For this reason, non-enzyme-inducing AEDs are preferable in the cancer setting.
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Affiliation(s)
- Jai Grewal
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 431, Houston, TX 77030, USA.
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Prasad N, Gulati S, Gupta RK, Sharma K, Gulati K, Sharma RK, Gupta A. Spectrum of radiological changes in hypertensive children with reversible posterior leucoencephalopathy. Br J Radiol 2007; 80:422-9. [PMID: 17392398 DOI: 10.1259/bjr/81758556] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
We prospectively studied 19 children with severe hypertension to evaluate the spectrum of radiological changes, severity and reversibility of this entity. All of them were subjected to clinical and biochemical evaluation, followed by magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA). Headache was seen in 17 children, 13 had confusion and drowsiness, 12 had nausea and vomiting, 10 patients had visual disturbances, seizure and dyspnoea. Only two had focal neurological deficit (one with right facial palsy and another with right lateral rectus palsy). Of these 19 children, 15 patients had hypertensive retinopathy and four had normal fundi. The positive MRI findings in 17/19 patients were: bilateral leukoencephalopathic changes in occipitoparietal region (9/17), diffuse white/grey matter lesion (3/17) patients, brain stem hyperintensity (2/17) and haemorrhagic lesions (3/17). On MRA, 12/19 patients had attenuation of cerebral arteries of different degree. On follow up, MRI findings resolved in all except three patients. All patients had normal MRA on follow up, except one with persistent minimal attenuation of middle cerebral artery and another had spasm in anterior, middle and posterior cerebral arteries. The intracranial abnormalities in these patients with severe hypertension were reversible in many of the cases after control of blood pressure was achieved. We therefore conclude that severe hypertension may lead to leuoencephalopathy, which had a wide radiological spectrum. A better understanding of this complex syndrome may obviate unnecessary investigations and allow management of associated problems in prompt and appropriate ways.
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Affiliation(s)
- N Prasad
- Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
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Ozkan A, Hakyemez B, Ozkalemkas F, Ali R, Ozkocaman V, Ozcelik T, Taskapilioglu O, Altundal Y, Tunali A. Tumor lysis syndrome as a contributory factor to the development of reversible posterior leukoencephalopathy. Neuroradiology 2006; 48:887-92. [PMID: 16983525 DOI: 10.1007/s00234-006-0142-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2006] [Accepted: 07/22/2006] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Reversible posterior leukoencephalopathy syndrome (RPLS) is a recently described clinical and radiological entity comprising headache, seizures, altered level of consciousness and visual disturbances in association with transient posterior cerebral white-matter abnormalities. METHOD We report a young woman with Burkitt's lymphoma who developed RPLS after combined chemotherapy administered during the tumor lysis syndrome. RESULTS The symptoms in this patient fitted well with those of RPLS; they included abrupt alterations in mental status, seizures, headache, visual changes and characteristic neuroradiological findings. She was given further combination chemotherapy without any neurological complications, at which time she had already recovered from both RPLS and tumor lysis syndrome. CONCLUSION Although many etiological factors have been reported in the development of RPLS, the underlying mechanism is not yet well understood. With prompt and appropriate management, RPLS is usually reversible, and chemotherapy can be continued after complete recovery from RPLS. We suggest that tumor lysis syndrome should be considered as a contributory factor to the development of RPLS in patients for whom treatment with combined chemotherapy for hematological malignancies is planned.
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Affiliation(s)
- A Ozkan
- Division of Hematology, Department of Internal Medicine, Uludag University Hospital, Uludag University School of Medicine, 16059 Bursa, Turkey.
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Ferraz-Filho JR, Rocha-Filho JA, Bichuette TF, de Albuquerque RCAP, Sanchez RA, Souza AS. Studying the evolution and the magnetic resonance findings of reversible posterior leukoencephalopathy in children. ARQUIVOS DE NEURO-PSIQUIATRIA 2006; 64:718-22. [PMID: 17057873 DOI: 10.1590/s0004-282x2006000500003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2006] [Accepted: 06/26/2006] [Indexed: 11/22/2022]
Abstract
PURPOSE: To describe the evolution and the magnetic resonance imaging (MRI) findings of the reversible posterior leukoencephalopathy (RLPS) in children. METHOD: Nine children with neurologic symptoms and sudden increase of the arterial pressure were studied by brain MRI. RESULTS: All children evaluated had lesions seen on FLAIR-weighted images of the parietal-occipital regions. Other regions were also involved. Four patients presented restriction on diffusion-weighted images and only two with reduction of the apparent diffusion coefficient (ADC), whitch evolved with neurologic sequels and persistence of the lesions on the control examination. The other patients had complete regression of the lesions after therapy. CONCLUSION: MRI is important to suggest the diagnosis of RPLS in patients with arterial hypertension and unspecific neurologic symptoms. Moreover, the outcome is not favorable all the time and the association of D-WI with ADC can be an instrument capable of predicting irreversible lesions.
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Affiliation(s)
- José Roberto Ferraz-Filho
- Department of Radiology, Faculdade de Medicina Estadual de Rio Preto, Hospital de Base de São Jose do Rio Preto SP, Rua Brigadeiro Faria Lima 5544, 15090-000 São Jose do Rio Preto SP, Brazil.
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