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Shash H, Aldaama S, Omer H, Alafghani S. Different Clinicoradiological Characteristics of Posterior Reversible Encephalopathy Syndrome in Pediatric Oncology and Post-Bone Marrow Transplantation Cases: A Retrospective Study. Front Neurol 2022; 13:836033. [PMID: 35599741 PMCID: PMC9120546 DOI: 10.3389/fneur.2022.836033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 03/29/2022] [Indexed: 11/23/2022] Open
Abstract
Posterior reversible encephalopathy syndrome (PRES) is receiving increasing recognition in pediatrics. However, comparisons between PRES in pediatric oncology and post-bone marrow transplantation (BMT) are lacking. Therefore, we aimed to describe the risk factors and clinical and radiological features of PRES and investigate the differences between PRES in pediatric oncology and post-BMT. The PRES data of 13 patients from our center were combined with those of 217 cases from the PubMed, Scopus, and Web of Science databases. The patients were divided into either an oncology or a post-BMT group. We included 230 patients in the analysis, 26.1% of whom belonged to the post-BMT group. Oncology patients developed PRES at a younger age (p = 0.010) and were more likely to develop encephalopathy (p = 0.004). Systemic hypertension (S-HTN) preceding PRES occurred in 43.5% (66/154) of patients. Post-BMT patients were more likely to have S-HTN (p = 0.003). Cyclosporine levels were detected in 37 patients; 40.5% had supra-therapeutic levels. The radiological findings were atypical in 74.3% of patients, and delayed repeated imaging increased the occurrence of resolution (p = 0.004). Sixteen (7%) patients developed PRES recurrence after a median of 8 weeks, with the between-group difference being non-significant. Oncology patients were more likely to develop chronic epilepsy, while BMT patients were more likely to develop rare neurologic abnormalities (p < 0.001). In conclusion, atypical clinical presentation and imaging findings should not hinder the diagnosis of PRES. S-HTN is a risk factor, particularly in post-BMT patients. Supra-therapeutic levels of cyclosporine and previous exposure to immunosuppression did not increase the risk of recurrence.
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Affiliation(s)
- Hwazen Shash
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
- Department of Pediatrics, King Fahad Hospital of the University, Al-Khobar, Saudi Arabia
- *Correspondence: Hwazen Shash ; orcid.org/0000-0002-4128-9504
| | - Saad Aldaama
- Department of Pediatric Hematology-Oncology and Stem Cell Transplantation, King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | - Hala Omer
- Department of Pediatric Hematology-Oncology and Stem Cell Transplantation, King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | - Sameera Alafghani
- Department of Pediatric Hematology-Oncology and Stem Cell Transplantation, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
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Posterior reversible encephalopathy syndrome in cancer patients: a single institution retrospective study. J Neurooncol 2016; 128:75-84. [DOI: 10.1007/s11060-016-2078-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Accepted: 02/15/2016] [Indexed: 10/22/2022]
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Posterior reversible encephalopathy syndrome (PRES) after combination chemotherapy for lymphoma. Am J Ther 2015; 21:e137-42. [PMID: 23075577 DOI: 10.1097/mjt.0b013e318262315b] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Posterior reversible encephalopathy syndrome (PRES) is a serious neurologic disorder marked by acute neurologic symptoms and classic neuroimaging lesions. It occurs in the setting of certain medications and predisposing clinical conditions. We present a case of PRES in a patient with mantle cell lymphoma treated with systemic and intrathecal chemotherapy. The literature suggests a propensity for PRES to arise from the combination of malignancy, intensive induction chemotherapy, and intrathecal administration. PRES is an uncommon and underappreciated complication of certain chemotherapy regimens. The risk of PRES in this setting needs to be considered in managing patients with hematologic malignancies.
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Kamiya-Matsuoka C, Cachia D, Olar A, Armstrong TS, Gilbert MR. Primary brain tumors and posterior reversible encephalopathy syndrome. Neurooncol Pract 2014; 1:184-190. [PMID: 26034631 PMCID: PMC4369712 DOI: 10.1093/nop/npu024] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Posterior reversible encephalopathy syndrome (PRES) is a neurotoxic encephalopathic state associated with reversible cerebral vasogenic edema. It is an increasingly recognized occurrence in the oncology population. However, it is very uncommon in patients with primary brain tumors (PBTs). The aim of this study was to analyze the clinicoradiological features and report the clinical outcomes of PRES in PBT patients. METHODS We identified 4 cases with PBT who developed PRES at MD Anderson Cancer Center (MDACC) between 2012 and 2014. Clinical and radiological data were abstracted from their records. In addition, we also solicited 8 cases from the literature. RESULTS The median age at PRES onset was 19 years, male-to-female ratio was 1:1, and the syndrome occurred in patients with ependymoma (n = 4), glioblastoma (n = 3), diffuse intrinsic pontine glioma (DIPG; n = 3), juvenile pilocytic astrocytoma (n = 1), and atypical meningioma (n = 1). Two glioblastomas and 2 DIPG cases received bevacizumab and vandetanib before the onset of symptoms, respectively. The most common clinical presentation was seizures (n = 7). Three MDACC patients recovered completely in 3-4 weeks after the onset of symptoms. One patient died due to active cancer and several comorbidities including PRES. CONCLUSIONS Hypertension seems to be the most important coexisting risk factor for development of PRES; however, the potential effects of chemotherapeutic agents in the pathogenesis of PRES should also be examined. The clinicoradiological course of PRES in PBT patients did not vary from the classical descriptions of PRES found in other causes. PRES must be considered as part of the differential diagnosis in patients with PBTs presenting with seizures or acute encephalopathy.
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Affiliation(s)
| | | | - Adriana Olar
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (C.K.-M., D.C., T.S.A., M.R.G.); Department of Family Health, The University of Texas Health Science Center School of Nursing, Houston, Texas (T.S.A.); Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas (A.O.)
| | - Terri S. Armstrong
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (C.K.-M., D.C., T.S.A., M.R.G.); Department of Family Health, The University of Texas Health Science Center School of Nursing, Houston, Texas (T.S.A.); Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas (A.O.)
| | - Mark R. Gilbert
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (C.K.-M., D.C., T.S.A., M.R.G.); Department of Family Health, The University of Texas Health Science Center School of Nursing, Houston, Texas (T.S.A.); Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas (A.O.)
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Le EM, Loghin ME. Posterior Reversible Encephalopathy Syndrome: A Neurologic Phenomenon in Cancer Patients. Curr Oncol Rep 2014; 16:383. [DOI: 10.1007/s11912-014-0383-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Araqi-Houssaini A, Salmi S, Moussaid I, Guennoun MA, Elyoussoufi S, Miguil M, Adil A, El Moutawakil B, Rafai MA, Slassi I. [Posterior reversible encephalopathy syndrome and eclampsia: a descriptive study of 13 cases in Morocco]. Rev Neurol (Paris) 2011; 167:812-9. [PMID: 21737111 DOI: 10.1016/j.neurol.2011.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2010] [Revised: 02/06/2011] [Accepted: 03/01/2011] [Indexed: 10/18/2022]
Abstract
INTRODUCTION The occurrence of posterior reversible encephalopathy in eclampsia is a rare but known event. We propose to describe the clinical and radiological features and the outcome. METHODS A retrospective study was conducted from January 2005 to April 2010 including all cases of posterior reversible encephalopathy syndrome (PRES) occurring on eclampsia in patients hospitalized in the obstetrical intensive care unit, University Hospital of Casablanca. RESULTS Thirteen cases of PRES on eclampsia were collected, the average age was 29 years (18-42). Systolic pressure and diastolic blood pressure at admission were higher than 150 mmHg and 100 respectively in 10 cases. The signs found were: a regressive blindness in five patients and focal signs in four. The complications were thrombocytopenia in 10 patients, abnormal liver function in eight, Hellp syndrome in nine, and acute renal failure in two. The brain regions most commonly affected were the parietal and occipital areas (13 patients), followed by temporal regions, frontal, and basal ganglia (eight patients each). Five patients required assisted ventilation (AV) over 24 hours. Death complicated the outcome in four of our patients, but no deaths were directly attributable to PRES itself, and all four patients had Hellp syndrome and required AV greater than 48 hours. In the other patients, total regression of neurological signs was noted. CONCLUSION This study emphasizes the severity of the Posterior 'reversible' encephalopathy syndrome on eclampsia.
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Affiliation(s)
- A Araqi-Houssaini
- Service d'Anesthésie-Réanimation Obstétricale, Centre Hospitalier Universitaire Ibn-Rochd, Casablanca, Maroc.
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Miles D, Bridgewater J, Ellis P, Harrison M, Nathan P, Nicolson M, Raouf S, Wheatley D, Plummer C. Using bevacizumab to treat metastatic cancer: UK consensus guidelines. Br J Hosp Med (Lond) 2011; 71:670-7. [PMID: 21135762 DOI: 10.12968/hmed.2010.71.12.670] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Concise guidance is lacking for the use of bevacizumab by practicing oncologists. Eight oncologists with experience of bevacizumab were joined by a cardiologist interested in treating hypertension to develop practical guidelines for managing patients receiving bevacizumab, using available clinical data.
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Affiliation(s)
- D Miles
- Mount Vernon Cancer Centre, London
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Heo S, Cho HJ, Jeon IS. A case of posterior reversible encephalopathy syndrome in a child with myelodysplastic syndrome following allogenic bone marrow transplantation. Pediatr Hematol Oncol 2010; 27:59-64. [PMID: 20121556 DOI: 10.3109/08880010903420661] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Posterior reversible encephalopathy syndrome (PRES) is an uncommon but distinctive clinical-radiologic entity characterized by headache, seizures, visual disturbance, and altered mental function associated with reversible white matter edema affecting the posterior parietal and occipital lobes of the brain. Although PRES is caused by a variety of conditions, acute elevation of blood pressure, fluid retention, and treatment with immunosuppressive drugs and/or anti-neoplastic agents are the main causes. A few cases of PRES associated with hematopoietic stem cell transplantation (HSCT) in children have been reported. Early recognition of PRES and appropriate management are needed to reduce the risk of permanent neurologic disability. The authors report a case of PRES in a girl who received an HLA-identical sibling bone marrow transplantation for myelodysplastic syndrome to emphasize the importance of early recognition and institution of appropriate management of PRES during HSCT.
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Affiliation(s)
- Seonhee Heo
- Department of Pediatrics, Gil Medical Center, School of Medicine, Gachon University of Medicine and Science, Incheon, Korea
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Bhatt A, Farooq MU, Majid A, Kassab M. Chemotherapy-related posterior reversible leukoencephalopathy syndrome. Nat Rev Neurol 2009; 5:163-9. [PMID: 19262592 DOI: 10.1038/ncpneuro1045] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2008] [Accepted: 01/13/2009] [Indexed: 11/09/2022]
Abstract
BACKGROUND A 45-year-old woman with small-cell lung cancer presented to a hospital emergency department in an acute confusional state, with blurred vision and mild headache. Following progressively increasing lethargy, she subsequently became unresponsive to tactile and verbal stimuli. She had recently been started on chemotherapy with carboplatin and gemcitabine. INVESTIGATIONS Physical examination, imaging studies including brain MRI, noncontrast brain CT scans and magnetic resonance angiography, continuous EEG monitoring, and cerebrospinal fluid analysis. DIAGNOSIS Posterior reversible leukoencephalopathy syndrome (PRES) related to chemotherapy, and nonconvulsive status epilepticus related to PRES. MANAGEMENT Withholding of chemotherapeutic agents, and antiseizure therapy for the status epilepticus.
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Affiliation(s)
- Archit Bhatt
- Department of Neurology and Ophthalmology, Michigan State University, East Lansing, MI 48823, USA.
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Kim JW, Moon JM, Kang EJ, Choi YJ, Kim JS, Choi JG, Seo HY, Sung HJ, Choi CW, Kim BS, Kim JS, Seo WK. Reversible Posterior Leukoencephalopathy Syndrome in a Patient with Relapsed Hodgkin's Disease: A Case Report. THE KOREAN JOURNAL OF HEMATOLOGY 2009. [DOI: 10.5045/kjh.2009.44.3.177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Jee Won Kim
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Ji Mi Moon
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Eun-Joo Kang
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Yoon Ji Choi
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Jung Sun Kim
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Jong Gwon Choi
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Hee Yeon Seo
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Hwa Jung Sung
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Chul Won Choi
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Byung Soo Kim
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Jun Suk Kim
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Woo-Keun Seo
- Department of Neurology, Korea University College of Medicine, Seoul, Korea
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