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Li J, Huang Y, Lao Q. Paclitaxel combined with trastuzumab chemotherapy-related posterior reversible encephalopathy syndrome: A case report and literature review. Radiol Case Rep 2024; 19:2188-2191. [PMID: 38515774 PMCID: PMC10950567 DOI: 10.1016/j.radcr.2024.02.073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 02/18/2024] [Accepted: 02/21/2024] [Indexed: 03/23/2024] Open
Abstract
Posterior reversible encephalopathy syndrome (PRES) in breast carcinoma is a rare disease in clinical practice that is often misdiagnosed and ignored. This study reported a case of a patient admitted to our hospital and discussed the clinical, imaging, and pathogenesis properties of the disease. We retrospectively analyzed the clinical data of this patient and reviewed the relevant literature. Imaging was used to diagnose PRES based on clinical findings, and clinical symptoms improved after discontinuation of the relevant drugs.
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Affiliation(s)
- Jing Li
- Department of Neurology, Guangxi medical university cancer hospital, Nanning, Guangxi, China, 530021
| | - Yanlan Huang
- Department of Neurology, Guangxi medical university cancer hospital, Nanning, Guangxi, China, 530021
| | - Qifang Lao
- Department of Intensive Care Medicine, Guangxi medical university cancer hospital, Nanning, Guangxi, China, 530021
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Lei CL, Gui XL, Wang LY, Guo YJ, Li Y. Analysis of drug-induced posterior reversible encephalopathy syndrome using the food and drug administration adverse drug events reporting system database. Expert Opin Drug Saf 2024; 23:607-616. [PMID: 38478961 DOI: 10.1080/14740338.2024.2327510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 01/03/2024] [Indexed: 05/12/2024]
Abstract
OBJECTIVE In this retrospective pharmacovigilance study, we gathered data on drug-induced posterior reversible encephalopathy syndrome (PRES). Our goal was to identify the primary suspect drugs in PRES by analyzing the Food and Drug Administration Adverse Events Reporting System (FAERS) database. METHODS We identified and analyzed reports of PRES listed in the FAERS database between 2004 and 2021. Using the reporting odds ratio and 95% confidence interval, we evaluated the safety signals for each of the drugs associated with PRES. RESULTS We reviewed 11,077 reports of adverse events corresponding to PRES. The primary suspect drug categories were antineoplastics, immunosuppressants, and glucocorticoids. PRES was 24.77% more likely to occur in females than in males. Drug-induced PRES usually occurs in individuals with cancer, those who have undergone an organ/stem cell transplant, and those with autoimmune conditions. CONCLUSION Our results show that the drugs most commonly suspected to cause PRES were antineoplastics, immunosuppressants, and glucocorticoids. Future studies are needed to illuminate the pathophysiological alterations that underlie PRES. In the meantime, prescribers and patients should be made aware of the potential risks of PRES associated with pharmaceutical therapy, and the summaries of product characteristics for individual drugs should be updated to include this information.
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Affiliation(s)
- Cai-Lu Lei
- Department of Pharmacy, Guangxi Medical University Cancer Hospital, Nanning, China
- School of Pharmaceutical Science, Guangxi Medical University, Nanning, China
| | - Xiao-Long Gui
- Department of Gastrointestinal & Gland Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Lin-Yu Wang
- Department of Pharmacy, Guangxi Medical University Cancer Hospital, Nanning, China
| | - You-Jia Guo
- Department of Pharmacy, Guangxi Medical University Cancer Hospital, Nanning, China
| | - Yan Li
- Department of Pharmacy, Guangxi Medical University Cancer Hospital, Nanning, China
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Varengue R, Delion M, De Carli E, Fournier LL, Durigneux J, Dinomais M, Van Bogaert P. Evaluation of safety of fluoxetine for cerebellar mutism syndrome in children after posterior fossa surgery. Arch Pediatr 2024; 31:231-237. [PMID: 38485568 DOI: 10.1016/j.arcped.2023.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 10/22/2023] [Accepted: 10/29/2023] [Indexed: 05/19/2024]
Abstract
BACKGROUND Cerebellar mutism syndrome (CMS) occurs in 8-29 % of children undergoing posterior fossa tumor surgery. Its main symptoms are mutism and emotional lability. Although it is always transient, recovery time can be lengthy with long-term cognitive sequelae. There is no approved drug treatment for CMS, but some drugs are used in everyday medical practice. One of these is fluoxetine, which has been used for many years in our institution. The main objective of this study was to establish the safety profile of fluoxetine in this condition. MATERIALS AND METHODS The records of patients admitted to the pediatric intensive care unit after brain surgery at Angers University Hospital from 2010 to 2020 were reviewed. Children aged 2 years and older who underwent a posterior fossa tumor surgery and were diagnosed with CMS were included. Data on patient characteristics, prescription of fluoxetine treatment, side effects if any, and complete mutism duration were collected. RESULTS Among 246 patients admitted to the pediatric intensive care unit for brain surgery during the study period, 23 had CMS and eight were prescribed fluoxetine. No serious adverse event related to fluoxetine was reported. Complete mutism duration did not differ significantly between the fluoxetine group and the non-fluoxetine group(p = 0.22). However, the treatment was initiated after recovery from complete mutism in half of the treated patients. CONCLUSION This study suggests a positive safety profile of fluoxetine used in postoperative CMS. It does not answer the question of whether the treatment is effective for this indication. A randomized controlled trial based on a syndrome severity scale should be conducted to provide a more reliable assessment of the efficacy and safety of fluoxetine.
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Affiliation(s)
- Roxane Varengue
- Department of Neuropediatrics and Pediatric Neurosurgery, Angers University Hospital, 4 rue Larrey, 49100 Angers, France.
| | - Matthieu Delion
- Department of Neuropediatrics and Pediatric Neurosurgery, Angers University Hospital, 4 rue Larrey, 49100 Angers, France
| | - Emilie De Carli
- Pediatric oncology department, Angers University Hospital, 4 rue Larrey, 49100 Angers, France
| | - Luc Le Fournier
- Department of Neuropediatrics and Pediatric Neurosurgery, Angers University Hospital, 4 rue Larrey, 49100 Angers, France
| | - Julien Durigneux
- Department of Neuropediatrics and Pediatric Neurosurgery, Angers University Hospital, 4 rue Larrey, 49100 Angers, France; Pediatric Physical Medicine and Rehabilitation Department, Les Capucins, 11 boulevard Jean Sauvage, 49100 Angers, France
| | - Mickael Dinomais
- Pediatric Physical Medicine and Rehabilitation Department, Les Capucins, 11 boulevard Jean Sauvage, 49100 Angers, France; Laboratoire Angevin de recherche en ingénierie des systèmes (LARIS) EA7315, University of Angers, 62 avenue Notre Dame du Lac 49000, Angers, France
| | - Patrick Van Bogaert
- Department of Neuropediatrics and Pediatric Neurosurgery, Angers University Hospital, 4 rue Larrey, 49100 Angers, France; Laboratoire Angevin de recherche en ingénierie des systèmes (LARIS) EA7315, University of Angers, 62 avenue Notre Dame du Lac 49000, Angers, France
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Srichawla BS, Presti K, Kipkorir V, Berrios Morales I. Chemotherapy-associated hemorrhagic posterior reversible encephalopathy syndrome (PRES) with considerations for circle of Willis variants on cerebral blood flow and autoregulation: A case report. Medicine (Baltimore) 2024; 103:e37250. [PMID: 38394546 DOI: 10.1097/md.0000000000037250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/25/2024] Open
Abstract
RATIONALE Hodgkin lymphoma, a lymphatic system cancer, is treated by chemotherapy, radiation therapy, and hematopoietic stem cell transplantation. Posterior reversible encephalopathy syndrome (PRES) is a rare neurotoxic effect associated with several drugs and systemic conditions. This case study emphasizes the potential risks of intensive chemotherapy regimens and postulates the impact of the circle of Willis variants on the heterogeneity of hemispheric lesions in PRES. PATIENT CONCERNS A 42-year-old woman diagnosed with stage IIA nodular sclerosing Hodgkin lymphoma and chronic thrombocytopenia presented after 6 years of initial diagnosis and 4 years post-haploidentical transplant. She underwent planned chemotherapy with ifosfamide, carboplatin, and etoposide. DIAGNOSES She developed an alteration in her mental status. A computerized tomography scan and angiogram of the head and neck revealed findings consistent with PRES and a left fetal-type posterior cerebral artery with an aplastic A1 segment of the left anterior cerebral artery. One hour later she was found comatose with clinical sequelae of an uncal herniation. INTERVENTIONS Subsequent events led to emergent intubation, and administration of 23.4% hypertonic saline. A repeat computerized tomography scan showed a right intraparenchymal hemorrhage with fluid-fluid levels measuring up to 4.7 cm, bilateral subarachnoid hemorrhage, right uncal herniation, and 15 mm of leftward midline shift. She emergently underwent a right decompressive hemi-craniectomy. OUTCOMES An magnetic resonance imaging of the brain demonstrated bilateral cytotoxic edema involving the parieto-occipital lobes. Despite interventions, the patient's neurological condition deteriorated, leading to a declaration of brain death on the 8th day. LESSONS This case underscores the importance of recognizing the severe neurological complications, including PRES, associated with chemotherapeutic treatments in Hodgkin lymphoma. PRES may also be exacerbated by coagulopathies such as thrombocytopenia in this case. The circle of Willis variants may influence cerebral blood flow, autoregulation, and other factors of hemodynamics, leading to increased susceptibility to both radiographic lesion burden and the worst clinical outcomes.
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Affiliation(s)
- Bahadar S Srichawla
- Department of Neurology, University of Massachusetts Chan Medical School, Worcester, MA
| | - Kendall Presti
- Department of Neurology, University of Massachusetts Chan Medical School, Worcester, MA
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Dirani K, Marusca G, Wang J, Juzych D. Capecitabine-induced posterior reversible encephalopathy syndrome (PRES) in a patient with gastric adenocarcinoma. BMJ Case Rep 2023; 16:e252059. [PMID: 38035676 PMCID: PMC10689393 DOI: 10.1136/bcr-2022-252059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2023] Open
Abstract
Posterior reversible encephalopathy syndrome (PRES) is characterised by encephalopathy, visual disturbances and seizures, accompanied by radiological parieto-occipital oedema. Immunosuppressive and immunomodulatory drugs are risk factors. While capecitabine-induced PRES cases are rare, this report details a young woman with advanced gastric adenocarcinoma on capecitabine. She exhibited symptoms of nausea, vomiting and abdominal pain before developing hypertension, drowsiness and a seizure. Brain MRI revealed parieto-occipital hyperintense areas indicative of PRES. Suspending capecitabine led to a gradually improved mental state. Prompt recognition and treatment of PRES offer reversibility, often achievable through dose reduction or discontinuation of the causative drug.
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Affiliation(s)
- Karim Dirani
- DMC, Detroit, Michigan, USA
- Ophthalmology, Kresge Eye Institute, Detroit, Michigan, USA
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Schroyen G, Sleurs C, Ottenbourgs T, Leenaerts N, Nevelsteen I, Melis M, Smeets A, Deprez S, Sunaert S. Changes in leukoencephalopathy and serum neurofilament after (neo)adjuvant chemotherapy for breast cancer. Transl Oncol 2023; 37:101769. [PMID: 37651891 PMCID: PMC10480307 DOI: 10.1016/j.tranon.2023.101769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 08/21/2023] [Accepted: 08/21/2023] [Indexed: 09/02/2023] Open
Abstract
BACKGROUND Previous case studies have provided evidence for chemotherapy-induced leukoencephalopathy in patients with breast cancer. However, prospective research is lacking. Hence, we investigated leukoencephalopathy before and after chemotherapy and its association with a serum neuroaxonal damage marker. METHODS This prospective cohort study included 40 patients receiving chemotherapy for breast cancer, and two age- and education-matched control groups, recruited between 2018 and 2021 (31-64 years of age). The latter control groups consisted of 39 chemotherapy-naïve patients and 40 healthy women. Fluid-attenuated inversion-recovery magnetic resonance imaging was used for lesion volumetry (total, juxtacortical, periventricular, infratentorial, and deep white matter) and blood serum to measure neurofilament light chain (NfL) levels. Acquisition took place pre-chemotherapy and three months and one-year post-chemotherapy, or at corresponding intervals. Within/between group differences were compared using robust mixed-effects modeling, and associations between total lesion volume and serum-NfL with linear regression. RESULTS Stronger increases in deep white matter lesion volumes were observed shortly post-chemotherapy, compared with healthy women (ßstandardized=0.09, pFDR<0.001). Increases in total lesion volume could mainly be attributed to enlargement of existing lesions (mean±SD, 0.12±0.16 mL), rather than development of new lesions (0.02±0.02 mL). A stronger increase in serum-NfL concentration was observed shortly post-chemotherapy compared with both control groups (ß>0.70, p<0.004), neither of which showed any changes over time, whereas a decrease was observed compared with healthy women one-year post-chemotherapy (ß=-0.54, p = 0.002). Serum-NfL concentrations were associated with lesion volume one-year post-chemotherapy (or at matched timepoint; ß=0.36, p = 0.010), whereas baseline or short-term post-therapy levels or changes were not. CONCLUSION These results underscore the possibility of chemotherapy-induced leukoencephalopathy months post-treatment, as well as the added value of serum-NfL as a prognostic marker for peripheral/central neurotoxicity. TRANSLATIONAL RELEVANCE Previous case studies have provided evidence of chemotherapy-induced leukoencephalopathy in patients with breast cancer. However, prospective studies to estimate longitudinal changes are currently missing. In this study, we used longitudinal fluid-attenuated inversion-recovery magnetic resonance imaging to assess white matter lesion volumes in patients treated for non-metastatic breast cancer and healthy women. Our findings demonstrate that chemotherapy-treated patients exhibit stronger increases in lesion volumes compared with healthy women, specifically in deep white matter, at three months post-chemotherapy. Increases could mainly be attributed to enlargement of existing lesions, rather than development of new lesions. Last, serum concentrations of neurofilament light chain, a neuroaxonal damage marker, increased shortly after chemotherapy and long-term post-chemotherapy levels were associated with lesion volumes. These findings highlight the potential of this non-invasive serum marker as a prognostic marker for peripheral and/or central neurotoxicity. Implementation in clinical practice could aid in therapeutic decisions, assessing disease activity, or monitoring treatment response.
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Affiliation(s)
- Gwen Schroyen
- KU Leuven, Leuven Brain Institute, Leuven, Belgium; University Hospitals Leuven, Leuven Cancer Institute, Leuven, Belgium; KU Leuven, Department of Imaging and Pathology, Translational MRI, Leuven, Belgium
| | - Charlotte Sleurs
- KU Leuven, Leuven Brain Institute, Leuven, Belgium; University Hospitals Leuven, Leuven Cancer Institute, Leuven, Belgium; Tilburg University, Department of Cognitive Neuropsychology, Tilburg, the Netherlands; KU Leuven, Department of Oncology, Leuven, Belgium
| | - Tine Ottenbourgs
- KU Leuven, Department of Imaging and Pathology, Translational MRI, Leuven, Belgium
| | - Nicolas Leenaerts
- KU Leuven, Leuven Brain Institute, Leuven, Belgium; KU Leuven, Department of Neurosciences, Mind-Body Research, Leuven, Belgium; KU Leuven, University Psychiatric Center, Leuven, Belgium; University Hospitals Leuven, Department of Psychiatry, Leuven, Belgium
| | - Ines Nevelsteen
- University Hospitals Leuven, Leuven Cancer Institute, Leuven, Belgium; KU Leuven, Department of Oncology, Leuven, Belgium; University Hospitals Leuven, Department of Oncology, Surgical Oncology, Leuven, Belgium
| | - Michelle Melis
- KU Leuven, Leuven Brain Institute, Leuven, Belgium; University Hospitals Leuven, Leuven Cancer Institute, Leuven, Belgium; KU Leuven, Department of Imaging and Pathology, Translational MRI, Leuven, Belgium
| | - Ann Smeets
- University Hospitals Leuven, Leuven Cancer Institute, Leuven, Belgium; KU Leuven, Department of Oncology, Leuven, Belgium; University Hospitals Leuven, Department of Oncology, Surgical Oncology, Leuven, Belgium
| | - Sabine Deprez
- KU Leuven, Leuven Brain Institute, Leuven, Belgium; University Hospitals Leuven, Leuven Cancer Institute, Leuven, Belgium; KU Leuven, Department of Imaging and Pathology, Translational MRI, Leuven, Belgium.
| | - Stefan Sunaert
- KU Leuven, Leuven Brain Institute, Leuven, Belgium; KU Leuven, Department of Imaging and Pathology, Translational MRI, Leuven, Belgium; University Hospitals Leuven, Department of Radiology, Leuven, Belgium
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Hayes J, Mahoney AB, Ayers C, Sarma A, Ess KC, Hunley TE, Smith CM. A rare cause of posterior reversible encephalopathy syndrome: Acute lymphoblastic leukemia. Clin Case Rep 2023; 11:e8238. [PMID: 38028041 PMCID: PMC10659917 DOI: 10.1002/ccr3.8238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 06/08/2023] [Accepted: 11/08/2023] [Indexed: 12/01/2023] Open
Abstract
Key Clinical Message The presentation of posterior reversible encephalopathy syndrome (PRES) as the initial presenting sign of acute lymphoblastic leukemia is unusual, as PRES is more often a complication of therapy. This case highlights the importance of maintaining a broad differential diagnosis for pediatric hypertension and its complications. Abstract A 6-year-old male presented with a seizure-like episode. Evaluation revealed hypertension and brain imaging showed findings consistent with posterior reversible encephalopathy syndrome. Complete blood count showed lymphoblasts, and the cause of his hypertension was determined to be renal infiltration of leukemia cells due to B-cell acute lymphoblastic leukemia.
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Affiliation(s)
- Jessica Hayes
- Department of Pediatrics, Vanderbilt University Medical CenterMonroe Carell Jr. Children's HospitalNashvilleTennesseeUSA
| | - Anne Byrd Mahoney
- Department of Pediatrics, Vanderbilt University Medical CenterMonroe Carell Jr. Children's HospitalNashvilleTennesseeUSA
- Division of Pediatric Hematology/OncologyVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Claci Ayers
- Department of Pediatrics, Vanderbilt University Medical CenterMonroe Carell Jr. Children's HospitalNashvilleTennesseeUSA
- Division of Pediatric Emergency MedicineVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Asha Sarma
- Department of RadiologyVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Kevin C. Ess
- Department of Pediatrics, Vanderbilt University Medical CenterMonroe Carell Jr. Children's HospitalNashvilleTennesseeUSA
- Division of Pediatric NeurologyVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Tracy E. Hunley
- Department of Pediatrics, Vanderbilt University Medical CenterMonroe Carell Jr. Children's HospitalNashvilleTennesseeUSA
- Division of Pediatric NephrologyVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Christine Moore Smith
- Department of Pediatrics, Vanderbilt University Medical CenterMonroe Carell Jr. Children's HospitalNashvilleTennesseeUSA
- Division of Pediatric Hematology/OncologyVanderbilt University Medical CenterNashvilleTennesseeUSA
- Vanderbilt‐Ingram Cancer CenterVanderbilt University Medical CenterNashvilleTennesseeUSA
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Xie L. Posterior reversible encephalopathy syndrome triggered by FLOT (5-fluorouracil, oxaliplatin, docetaxel, and calcium levofolinate) chemotherapy and thrombocytopenia (docetaxel and cisplatin) chemotherapy. J Oncol Pharm Pract 2023; 29:1503-1509. [PMID: 37218162 DOI: 10.1177/10781552231177597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
INTRODUCTION Posterior reversible encephalopathy syndrome is a clinical and imaging syndrome characterized by endothelial dysfunction, blood-brain barrier disruption, and vasogenic edema. The common clinical symptoms of posterior reversible encephalopathy syndrome include headache, altered consciousness, visual disturbances, and seizures, among which headache and seizures are the most common. The classic imaging patterns usually reveal vasogenic edema. CASE REPORT We describe the case of a middle-aged woman with gastric cancer. She was under treatment by fluorouracil, leucovorin, oxaliplatin, and docetaxel regimen and thrombocytopenia regimen after tumor progression, but developed unconsciousness, irritability, and headache shortly after initiation of treatment. Her magnetic resonance imaging in our hospital shows abnormal signals in bilateral frontal parietal occipital lobes with hyperintensities on T2-weighted magnetic resonance imaging and fluid-attenuated inversion recovery imaging, accompanied by the increased value of apparent diffusion coefficient. And T1-weighted images illustrate hypointense foci, with increased diffusion-weighted imaging signals. MANAGEMENT AND OUTCOME After admission, she was treated to control blood pressure, reduce brain edema, expand blood vessels, improve consciousness, and symptomatic support treatment. 3 days after the onset of the disease, her headache symptoms and state of consciousness gradually improved, and her blood pressure can be controlled at about 130/80 mmHg. DISCUSSION This is the first report that posterior reversible encephalopathy syndrome is caused by a thrombocytopenia regimen, and our case highlights the pathogenic role of a thrombocytopenia regimen in posterior reversible encephalopathy syndrome. However, the association between the thrombocytopenia regimen and previous fluorouracil, leucovorin, oxaliplatin, and docetaxel regimens needs further study.
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Affiliation(s)
- LinLin Xie
- Department of Neurology, Affiliated Hospital of Qingdao University, Shandong, China
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Bonura A, Iaccarino G, Rossi SS, Capone F, Motolese F, Calandrelli R, Di Lazzaro V, Pilato F. Posterior reversible encephalopathy syndrome and reversible cerebral vasoconstriction syndrome in patients with COVID-19 infection: is there a link? A systematic review and case report analysis. J Neurol 2023; 270:2826-2852. [PMID: 37014421 PMCID: PMC10071475 DOI: 10.1007/s00415-023-11684-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 02/26/2023] [Accepted: 03/21/2023] [Indexed: 04/05/2023]
Abstract
During the SARS-CoV2 pandemic, several cases of Posterior Reversible Encephalopathy Syndrome (PRES) and of Reversible Cerebral Vasoconstriction Syndrome (RCVS) in COVID-19 patients have been reported, but the link between these syndromes and COVID-19 is unclear. We performed a systematic review, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement to evaluate whether SARS-CoV2 infection or the drugs used to treat it could be deemed potential risk factors for PRES or RCVS. We performed a literature search. We found 70 articles (60 on PRES and 10 on RCVS) concerning n = 105 patients (n = 85 with PRES, n = 20 with RCVS). We analyzed the clinical characteristics of the two populations separately, then performed an inferential analysis to search for other independent risk factors. We found fewer than usual PRES-related (43.9%) and RCVS-related (45%) risk factors in patients with COVID-19. Such a low incidence of risk factors for PRES and RCVS might suggest the involvement of COVID-19 as an additional risk factor for both diseases due to its capability to cause endothelial dysfunction. We discuss the putative mechanisms of endothelial damage by SARS-CoV2 and antiviral drugs which may underlie the development of PRES and RCVS.
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Affiliation(s)
- Adriano Bonura
- Department of Medicine and Surgery, Unit of Neurology, Neurophysiology, Neurobiology and Psychiatry, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128, Rome, Italy
- Institute of Neurology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128, Rome, Italy
| | - Gianmarco Iaccarino
- Department of Medicine and Surgery, Unit of Neurology, Neurophysiology, Neurobiology and Psychiatry, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128, Rome, Italy
- Institute of Neurology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128, Rome, Italy
| | - Sergio Soeren Rossi
- Department of Medicine and Surgery, Unit of Neurology, Neurophysiology, Neurobiology and Psychiatry, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128, Rome, Italy
- Institute of Neurology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128, Rome, Italy
| | - Fioravante Capone
- Department of Medicine and Surgery, Unit of Neurology, Neurophysiology, Neurobiology and Psychiatry, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128, Rome, Italy
- Institute of Neurology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128, Rome, Italy
| | - Francesco Motolese
- Department of Medicine and Surgery, Unit of Neurology, Neurophysiology, Neurobiology and Psychiatry, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128, Rome, Italy
- Institute of Neurology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128, Rome, Italy
| | - Rosalinda Calandrelli
- Institute of Radiology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo A. Gemelli, 1, 00168, Rome, Italy
| | - Vincenzo Di Lazzaro
- Department of Medicine and Surgery, Unit of Neurology, Neurophysiology, Neurobiology and Psychiatry, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128, Rome, Italy
- Institute of Neurology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128, Rome, Italy
| | - Fabio Pilato
- Department of Medicine and Surgery, Unit of Neurology, Neurophysiology, Neurobiology and Psychiatry, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128, Rome, Italy.
- Institute of Neurology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128, Rome, Italy.
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Balcerac A, Bihan K, Psimaras D, Lebrun-Vignes B, Salem JE, Weiss N. Drugs associated with posterior reversible encephalopathy syndrome, a worldwide signal detection study. J Neurol 2023; 270:975-985. [PMID: 36329183 DOI: 10.1007/s00415-022-11450-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 10/21/2022] [Accepted: 10/22/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Posterior reversible encephalopathy syndrome (PRES) can occur in a variety of clinical conditions, such as severe hypertension, pregnancy, inflammatory diseases, hematopoietic stem cells or solid organ transplantation. Apart increased blood pressure levels and altered renal function, several drugs have been reported as potential triggering factor. These descriptions are nevertheless limited to case reports or small case series. Systematic analysis of drugs associated with PRES using global pharmacovigilance database is lacking and can be useful. METHODS We performed a disproportionality analysis using VigiBase, the World Health Organization pharmacovigilance database, using the information component (IC). The IC compares observed and expected values to find associations between drugs and PRES using disproportionate Bayesian reporting. An IC0.25 (lower end of the IC 95% credibility interval) > 0 is considered statistically significant. RESULTS Here we present an analysis of 3278 cases of PRES reported in VigiBase. These results identified 73 molecules statistically associated with PRES using full database as background with an IC0.25 > 0. Only 34% (N = 25/73) of them had this information written in the summary of product characteristics. The main drug classes involved were antineoplastic and immunomodulating agents and the drugs with the greatest number of cases were tacrolimus, cyclosporin, bevacizumab, methotrexate, and vincristine. An overall mortality of 8.1% (N = 267/3278) was identified in cases of drug-associated PRES. CONCLUSION These results will help clinicians identify potential suspected drugs associated with PRES and decide which drug to discontinue and eventually lead to a re-evaluation of drug labels for some molecules.
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Affiliation(s)
- Alexander Balcerac
- département de neurologie, unité de Médecine Intensive Réanimation à orientation neurologique, Sorbonne Université, AP-HP.Sorbonne Université, Hôpital de la Pitié-Salpêtrière, Paris, France. .,Groupe de Recherche Clinique en REanimation et Soins intensifs du Patient en Insuffisance Respiratoire aiguE (GRC-RESPIRE) Sorbonne Université, 47-83, boulevard de l'hôpital, 75013, Paris, France.
| | - Kevin Bihan
- Department of Pharmacology, Regional Pharmacovigilance Center, Sorbonne Université, AP-HP.Sorbonne Université, Pitié-Salpêtrière Hospital, INSERM, CIC-1901, Sorbonne Universités, Paris, France
| | - Dimitri Psimaras
- service de neuro-oncologie, DMU Neurosciences, Groupe OncoNeuro Tox, Sorbonne Université, AP-HP.Sorbonne Université, Hôpital de la Pitié-Salpêtrière, Paris, France
| | - Bénédicte Lebrun-Vignes
- Department of Pharmacology, Regional Pharmacovigilance Center, Sorbonne Université, AP-HP.Sorbonne Université, Pitié-Salpêtrière Hospital, INSERM, CIC-1901, Sorbonne Universités, Paris, France
| | - Joe-Elie Salem
- Department of Pharmacology, Regional Pharmacovigilance Center, Sorbonne Université, AP-HP.Sorbonne Université, Pitié-Salpêtrière Hospital, INSERM, CIC-1901, Sorbonne Universités, Paris, France
| | - Nicolas Weiss
- département de neurologie, unité de Médecine Intensive Réanimation à orientation neurologique, Sorbonne Université, AP-HP.Sorbonne Université, Hôpital de la Pitié-Salpêtrière, Paris, France.,Groupe de Recherche Clinique en REanimation et Soins intensifs du Patient en Insuffisance Respiratoire aiguE (GRC-RESPIRE) Sorbonne Université, 47-83, boulevard de l'hôpital, 75013, Paris, France
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11
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Li Y, Song J, Huq AM, Timilsina S, Gershwin ME. Posterior reversible encephalopathy syndrome and autoimmunity. Autoimmun Rev 2023; 22:103239. [PMID: 36464226 DOI: 10.1016/j.autrev.2022.103239] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 11/27/2022] [Indexed: 12/03/2022]
Abstract
Posterior reversible encephalopathy syndrome (PRES) is a clinical syndrome characterized by acute or subacute onset of neurological symptoms (e.g., headache, seizure, confusion, vomiting, and diminished eyesight) and impaired endothelial barrier function of the cerebral circulation that leads to bilateral subcortical vasogenic edema, while exhibiting a "reversible" feature in most cases. Clinically, various predisposing or precipitating conditions have been identified, such as hypertension, autoimmune diseases, renal dysfunction/failure, preeclampsia/eclampsia, post-transplantation conditions, and certain therapeutic agents. Among several putative mechanisms, the immune activation hypothesis prevails, as up to 50% of patients with PRES harbor abnormalities related to autoimmunity, such as concurrent systemic lupus erythematosus. In this Review, we summarize the clinical and laboratory evidence that places PRES in the context of autoimmunity.
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Affiliation(s)
- Yang Li
- Department of Critical Care Medicine, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, PR China
| | - Junmin Song
- Department of Gastroenterology, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, PR China.
| | - Ahm M Huq
- Department of Pediatrics, Central Michigan University, Detroit, MI 48201, USA
| | - Suraj Timilsina
- Division of Rheumatology/Allergy and Clinical Immunology, School of Medicine, University of California, Davis, CA 95616, USA
| | - M Eric Gershwin
- Division of Rheumatology/Allergy and Clinical Immunology, School of Medicine, University of California, Davis, CA 95616, USA
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12
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Zupancic M, Farrajota Neves da Silva P, Kas Elyas K, Friesland S, Ellingsen Cederö T, Gerling M. Transient Coma and Signs of Encephalopathy Related to 5-Fluorouracil and Carboplatin: A Case Report. Case Rep Oncol 2023; 16:525-531. [PMID: 37485017 PMCID: PMC10359680 DOI: 10.1159/000531472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 05/26/2023] [Indexed: 07/25/2023] Open
Abstract
Chemotherapy-related encephalopathy is a rare but severe side effect of cancer therapy. Few reports exist on the course of encephalopathy due to 5-fluorouracil (5FU)/carboplatin treatment. Here, we report on a patient in his 70s, who received first-line palliative treatment with carboplatin followed by continuous infusion of 5FU against a metastasized cancer of the base of the tongue. During the first 5FU infusion, the patient developed a coma with sudden onset. In contrast to earlier reports of 5FU-induced encephalopathy, serum ammonium levels were near-normal, despite a slightly increased bilirubin. The electroencephalogram showed signs of general encephalopathy, for which no other probable cause than chemotherapy could be identified. Based on historical reports, the patient's encephalopathy was likely due to 5FU treatment rather than carboplatin. While initially in a coma with a Glasgow Coma Scale score of three, the patient regained consciousness within 3 days of supportive therapy. This case highlights the potentially benign clinical course of 5FU-induced encephalopathy, characterized by fulminant clinical deterioration and quick recovery. Such a rapid deterioration in a palliative setting can pose a clinical dilemma, where invasive treatments such as intubation must be weighed against a limited prognosis, for which this case may provide guidance.
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Affiliation(s)
- Mark Zupancic
- Medical Unit Head, Neck, Lung, and Skin Cancer, Theme Cancer, Karolinska University Hospital, Stockholm, Sweden
- Department of Oncology-Pathology, Karolinska Institutet, Solna, Sweden
| | - Pedro Farrajota Neves da Silva
- Department of Oncology-Pathology, Karolinska Institutet, Solna, Sweden
- Clinical Pathology and Cancer Diagnostics, Karolinska University Hospital, Stockholm, Sweden
| | - Karam Kas Elyas
- Medical Unit Head, Neck, Lung, and Skin Cancer, Theme Cancer, Karolinska University Hospital, Stockholm, Sweden
| | - Signe Friesland
- Medical Unit Head, Neck, Lung, and Skin Cancer, Theme Cancer, Karolinska University Hospital, Stockholm, Sweden
- Department of Oncology-Pathology, Karolinska Institutet, Solna, Sweden
| | - Thomasine Ellingsen Cederö
- Medical Unit Head, Neck, Lung, and Skin Cancer, Theme Cancer, Karolinska University Hospital, Stockholm, Sweden
| | - Marco Gerling
- Medical Unit Head, Neck, Lung, and Skin Cancer, Theme Cancer, Karolinska University Hospital, Stockholm, Sweden
- Department of Biosciences and Nutrition, Karolinska Institutet, Huddinge, Sweden
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13
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Heidari S, Panahishokouh M, Babakhani D, Aghabeigi S, Vaezi M, Amini S, Hadjibabaie M, Shahrami B. Vincristine-Induced Seizure from Drug Interactions: A Case Report and Review of Literature. Case Rep Oncol 2023; 16:363-371. [PMID: 37384200 PMCID: PMC10293935 DOI: 10.1159/000530655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Accepted: 03/28/2023] [Indexed: 06/30/2023] Open
Abstract
Vincristine (VCR) as a key drug for the treatment of acute lymphoblastic leukemia (ALL) is associated with neurotoxicity. We present a young man with a history of controlled childhood seizures who was diagnosed with pre-B-cell ALL and developed generalized tonic-clonic seizures following the Cancer and Leukemia Group B (CALGB) 8811 regimen. The patient also received oral itraconazole to prevent fungal infection initiated by chemotherapy. Possible causes of seizure, including electrolyte abnormalities, hypoglycemia, central nervous system infection or inflammation, were ruled out. According to the Naranjo Adverse Drug Reaction Scale, the patient's seizure had been attributed to VCR, possibly secondary to concomitant use of itraconazole and doxorubicin. The patient successfully recovered after discontinuation of VCR and supportive care. Clinicians should be aware of the possibility of vincristine-induced seizure in adult patients, especially with the concomitant use of drugs known to have potential drug-drug interactions.
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Affiliation(s)
- Shima Heidari
- Department of Clinical Pharmacy, School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahsa Panahishokouh
- Department of Clinical Pharmacy, School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Davoud Babakhani
- Hematology, Oncology and Stem Cell Transplantation Research Center, Research Institute for Oncology, Hematology, and Cell Therapy, Tehran University of Medical Sciences, Tehran, Iran
| | - Sohrab Aghabeigi
- Hematology, Oncology and Stem Cell Transplantation Research Center, Research Institute for Oncology, Hematology, and Cell Therapy, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Vaezi
- Hematology, Oncology and Stem Cell Transplantation Research Center, Research Institute for Oncology, Hematology, and Cell Therapy, Tehran University of Medical Sciences, Tehran, Iran
| | - Shahideh Amini
- Department of Clinical Pharmacy, School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Molouk Hadjibabaie
- Department of Clinical Pharmacy, School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Bita Shahrami
- Department of Clinical Pharmacy, School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
- Hematology, Oncology and Stem Cell Transplantation Research Center, Research Institute for Oncology, Hematology, and Cell Therapy, Tehran University of Medical Sciences, Tehran, Iran
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14
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He X, Shi D, Long C, Yang J, Tian J. Posterior reversible encephalopathy syndrome in a child after burns: A case report and literature review. SAGE Open Med Case Rep 2023; 11:2050313X231157988. [PMID: 36937809 PMCID: PMC10021091 DOI: 10.1177/2050313x231157988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 01/31/2023] [Indexed: 03/17/2023] Open
Abstract
Posterior reversible encephalopathy syndrome is a clinical-neuroradiological syndrome with typical neuroimaging features of posterior cerebral white matter changes that are usually reversible. However, there are only few reports of burns with posterior reversible encephalopathy syndrome in the literature. Hence, it is a clinical entity that many burn medicine physicians may be unfamiliar with. We report a case of severe burns complicated by posterior reversible encephalopathy syndrome in a 14-month-old male patient. On the eighth day of hospitalization, the child had persistent fever, occasional convulsions, eyes staring to the right, and high-pitched cry. Magnetic resonance imaging on day 10 showed the diagnosis is posterior reversible encephalopathy syndrome. We used hormone therapy to reduce cerebral oedema, oxcarbazepine to control convulsions, and multiple other drugs and physical measures to treat fever. The symptoms, signs, and imaging abnormalities of his posterior reversible encephalopathy syndrome were rapidly reversed in a short period of time. At the 1-year follow-up, the patient had recovered completely with no residual neurological signs and symptoms. To our knowledge, the patient may be the youngest recorded patient with both burns and posterior reversible encephalopathy syndrome. Careful observation, computed tomography, and magnetic resonance imaging can achieve early detection, early diagnosis, and early treatment of posterior reversible encephalopathy syndrome, which facilitates the achievement of desired therapeutic results. Further investigation is required to determine whether burns can serve as an independent posterior reversible encephalopathy syndrome causative factor and clarify the underlying pathogenesis mechanism.
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Affiliation(s)
- Xiaoying He
- Department of Plastic Surgery,
Zhongshan City People’s Hospital, Zhongshan, China
| | - Dandan Shi
- Department of Plastic Surgery,
Zhongshan City People’s Hospital, Zhongshan, China
| | - Chenyan Long
- Department of Plastic Surgery,
Zhongshan City People’s Hospital, Zhongshan, China
- Department of Plastic Surgery,
Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Jia Yang
- Department of Pediatric Intensive Care
Unit, Zhongshan City People’s Hospital, Zhongshan, China
| | - Ju Tian
- Department of Plastic Surgery,
Zhongshan City People’s Hospital, Zhongshan, China
- Ju Tian, Department of Plastic Surgery,
Zhongshan City People’s Hospital, 2 Sunwen East Road, Zhongshan 528400,
Guangdong, China.
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15
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Patil NS, Larocque N, van der Pol CB, Torres C, Raptis DA, Patlas MN. Chemotherapy-Induced Toxicities: An Imaging Primer. Can Assoc Radiol J 2022; 74:432-445. [PMID: 35968850 DOI: 10.1177/08465371221120263] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
The Coronavirus Disease of 2019 (COVID-19) pandemic has caused significant delays in the delivery of cancer treatments in Canada. As cancer treatment and imaging volumes return to normal, radiologists will encounter more cases of chemotherapy-induced toxicities. These toxicities have varied appearances on imaging, and can affect multiple organ systems. The purpose of this review is to offer a unified resource for general radiologists regarding the imaging appearances of chemotherapy-induced toxicities.
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Affiliation(s)
- Nikhil S. Patil
- Michael DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Natasha Larocque
- Department of Radiology, McMaster University, Hamilton, ON, Canada
| | - Christian B. van der Pol
- Department of Diagnostic Imaging, Juravinski Hospital and Cancer Centre, Hamilton Health Sciences, Canada
| | - Carlos Torres
- Department of Radiology, Radiation Oncology and Medical Physics, University of Ottawa, Ottawa, ON, Canada
| | - Demetrios A. Raptis
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, USA
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16
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Naman J, Saglamer N, Yock T, Pugh J, Pastena G, Weintraub L. Posterior reversible encephalopathy syndrome and necrotizing enterocolitis in a pediatric patient with medulloblastoma and COVID-19 infection. Pediatr Blood Cancer 2022; 70:e29868. [PMID: 35841310 PMCID: PMC9349640 DOI: 10.1002/pbc.29868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 06/14/2022] [Accepted: 06/16/2022] [Indexed: 12/25/2022]
Affiliation(s)
| | - Nicole Saglamer
- Department of PediatricsAlbany Medical CenterAlbanyNew YorkUSA
| | - Torun Yock
- Department of Radiation OncologyMassachusetts General HospitalBostonMassachusettsUSA
| | - John Pugh
- Department of Child NeurologyAlbany Medical CenterAlbanyNew YorkUSA
| | - Gaetano Pastena
- Department of RadiologyAlbany Medical CenterAlbanyNew YorkUSA
| | - Lauren Weintraub
- Department of Pediatric NeurooncologyAlbany Medical CenterAlbanyNew YorkUSA
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17
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Ruggi A, Melchionda F, Sardi I, Pavone R, Meneghello L, Kitanovski L, Zaletel LZ, Farace P, Zucchelli M, Scagnet M, Toni F, Righetto R, Cianchetti M, Prete A, Greto D, Cammelli S, Morganti AG, Rombi B. Toxicity and Clinical Results after Proton Therapy for Pediatric Medulloblastoma: A Multi-Centric Retrospective Study. Cancers (Basel) 2022; 14:2747. [PMID: 35681727 PMCID: PMC9179586 DOI: 10.3390/cancers14112747] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 05/28/2022] [Accepted: 05/30/2022] [Indexed: 02/04/2023] Open
Abstract
Medulloblastoma is the most common malignant brain tumor in children. Even if current treatment dramatically improves the prognosis, survivors often develop long-term treatment-related sequelae. The current radiotherapy standard for medulloblastoma is craniospinal irradiation with a boost to the primary tumor site and to any metastatic sites. Proton therapy (PT) has similar efficacy compared to traditional photon-based radiotherapy but might achieve lower toxicity rates. We report on our multi-centric experience with 43 children with medulloblastoma (median age at diagnosis 8.7 years, IQR 6.6, M/F 23/20; 26 high-risk, 14 standard-risk, 3 ex-infant), who received active scanning PT between 2015 and 2021, with a focus on PT-related acute-subacute toxicity, as well as some preliminary data on late toxicity. Most acute toxicities were mild and manageable with supportive therapy. Hematological toxicity was limited, even among HR patients who underwent hematopoietic stem-cell transplantation before PT. Preliminary data on late sequelae were also encouraging, although a longer follow-up is needed.
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Affiliation(s)
- Alessandro Ruggi
- Specialty School of Paediatrics-Alma Mater Studiorum, Università di Bologna, 40138 Bologna, Italy;
| | - Fraia Melchionda
- Pediatric Onco-Hematology, IRCCS Sant’Orsola SSD, University Hospital of Bologna, 40138 Bologna, Italy; (F.M.); (A.P.)
| | - Iacopo Sardi
- Neuro-Oncology Unit, Department of Pediatric Oncology, Meyer Children’s Hospital, 50139 Florence, Italy; (I.S.); (R.P.)
| | - Rossana Pavone
- Neuro-Oncology Unit, Department of Pediatric Oncology, Meyer Children’s Hospital, 50139 Florence, Italy; (I.S.); (R.P.)
| | - Linda Meneghello
- Pediatric Onco-Hematology Service, Pediatric Unit, Santa Chiara Hospital, 38123 Trento, Italy;
| | - Lidija Kitanovski
- Department of Oncology and Haematology, University Children’s Hospital, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia;
| | | | - Paolo Farace
- Proton Therapy Unit, Santa Chiara Hospital, Azienda Provinciale per i Servizi Sanitari (APSS), 38123 Trento, Italy; (P.F.); (R.R.); (M.C.)
| | - Mino Zucchelli
- Pediatric Neurosurgery, Institute of Neurological Science, IRCCS Bellaria Hospital, 40139 Bologna, Italy;
| | - Mirko Scagnet
- Department of Neurosurgery, Meyer Children’s Hospital, 50139 Florence, Italy;
| | - Francesco Toni
- Neuroradiology Unit, IRCCS Istituto delle Scienze Neurologiche di Bologna, 40139 Bologna, Italy;
| | - Roberto Righetto
- Proton Therapy Unit, Santa Chiara Hospital, Azienda Provinciale per i Servizi Sanitari (APSS), 38123 Trento, Italy; (P.F.); (R.R.); (M.C.)
| | - Marco Cianchetti
- Proton Therapy Unit, Santa Chiara Hospital, Azienda Provinciale per i Servizi Sanitari (APSS), 38123 Trento, Italy; (P.F.); (R.R.); (M.C.)
| | - Arcangelo Prete
- Pediatric Onco-Hematology, IRCCS Sant’Orsola SSD, University Hospital of Bologna, 40138 Bologna, Italy; (F.M.); (A.P.)
| | - Daniela Greto
- Azienda Ospedaliero-Universitaria Careggi, 50134 Florence, Italy;
| | - Silvia Cammelli
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (S.C.); (A.G.M.)
- Department of Experimental, Diagnostic and Specialty Medicine-DIMES, Alma Mater Studiorum, University of Bologna, 40138 Bologna, Italy
| | - Alessio Giuseppe Morganti
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (S.C.); (A.G.M.)
- Department of Experimental, Diagnostic and Specialty Medicine-DIMES, Alma Mater Studiorum, University of Bologna, 40138 Bologna, Italy
| | - Barbara Rombi
- Proton Therapy Unit, Santa Chiara Hospital, Azienda Provinciale per i Servizi Sanitari (APSS), 38123 Trento, Italy; (P.F.); (R.R.); (M.C.)
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18
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Jennane S, Mahtat EM, Ababou M, El Maaroufi H, Doghmi K. Posterior Reversible Encephalopathy Syndrome Secondary to R-CHOP Chemotherapy Regimen. Cureus 2022; 14:e24988. [PMID: 35719806 PMCID: PMC9191265 DOI: 10.7759/cureus.24988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2022] [Indexed: 11/05/2022] Open
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19
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Asakawa S, Arai S, Kawagoe M, Ohata C, Ono W, Murata H, Tamura Y, Uchida S, Shibata S, Fujigaki Y. A Young Patient with Microscopic Polyangiitis Requiring Hemodialysis with Complications of Repeated Episodes of Posterior Reversible Encephalopathy Syndrome Probably Due to Different Etiologies. Intern Med 2022; 61:1423-1431. [PMID: 34645762 PMCID: PMC9152853 DOI: 10.2169/internalmedicine.7941-21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
A young woman with microscopic polyangiitis (MPA) requiring hemodialysis showed repeated posterior reversible encephalopathy syndrome (PRES) with spatiotemporal multiple lesions over a period of two months. The first PRES episode with confusion and the second PRES episode with vertigo and nausea were caused by MPA, hypertension and renal failure. These symptoms were improved by the reinforcement of MPA treatment and blood pressure management. The third PRES episode with nausea, headache, seizure and visual changes was induced by rituximab infusion and hypertension. The PRES was improved with blood pressure and convulsant management. These conditions are challenging to diagnose and treat.
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Affiliation(s)
- Shinichiro Asakawa
- Department of Internal Medicine, Teikyo University School of Medicine, Japan
| | - Shigeyuki Arai
- Department of Internal Medicine, Teikyo University School of Medicine, Japan
| | - Mika Kawagoe
- Department of Internal Medicine, Teikyo University School of Medicine, Japan
| | - Chiaki Ohata
- Department of Internal Medicine, Teikyo University School of Medicine, Japan
| | - Wataru Ono
- Department of Internal Medicine, Teikyo University School of Medicine, Japan
| | - Hiroshi Murata
- Department of Internal Medicine, Teikyo University School of Medicine, Japan
| | - Yoshifuru Tamura
- Department of Internal Medicine, Teikyo University School of Medicine, Japan
| | - Shunya Uchida
- Department of Internal Medicine, Teikyo University School of Medicine, Japan
| | - Shigeru Shibata
- Department of Internal Medicine, Teikyo University School of Medicine, Japan
| | - Yoshihide Fujigaki
- Department of Internal Medicine, Teikyo University School of Medicine, Japan
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20
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Deng T, Zhang X, Peng X, Peng H, He L, Hu Y. Clinical features and prognostic analysis of posterior reversible encephalopathy syndrome in children. Int J Dev Neurosci 2022; 82:349-360. [PMID: 35373858 DOI: 10.1002/jdn.10184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 02/05/2022] [Accepted: 04/01/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND We aimed to investigate the clinical features and prognosis of posterior reversible encephalopathy syndrome (PRES) in children. METHODS Clinical data of children with PRES diagnosed at the Children's Hospital of Chongqing Medical University from June 2015 to May 2019 were retrospectively analyzed. RESULTS The study enrolled 47 patients with a mean age at diagnosis of 8.79 ± 3.72 years (range, 2-15 years). PRES causes included renal disorder (29/47), hematological disease (13/47), and hypertension (5/47). PRES manifested as seizure (43/47), headache (28/47), visual impairment (18/47), dizziness (18/47), vomiting (18/47), and mental and behavioral abnormalities (17/47). Forty-six children had hypertension (46/47) at PRES onset. Magnetic resonance imaging (MRI) mainly involved the parietal and occipital lobes (42/47), 38 cases were mild (38/47), 7 were moderate (7/47), and 2 were severe (2/47). The clinical symptoms of 41 patients (41/47) were relieved within 1-2 weeks. Thirty-seven children were followed up for 7-54 months (modified Rankin Scale). Twenty-five children had favorable outcomes (25/37). Twelve children had adverse outcomes (12/37), including epilepsy, disorders of consciousness, visual impairment, and mental decline. Analysis of single factors revealed that severity on MRI, length of in-hospital stay, and mental and behavioral abnormalities were related to adverse outcomes after PRES. Analysis of multiple factors revealed that severity on MRI and length of in-hospital stay were independent risk factors for PRES. CONCLUSION Pediatric PRES is a clinical radiographic syndrome with multiple etiologies. Most patients have a good prognosis. Severity on MRI and length of in-hospital stay are independent risk factors.
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Affiliation(s)
- Ting Deng
- Department of Neurology Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders. Chongqing Key Laboratory of Pediatrics, China.,Xi'an Children's Hospital, China
| | - Xinyu Zhang
- Department of Neurology Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders. Chongqing Key Laboratory of Pediatrics, China
| | - Xiaoling Peng
- Division of Science and Technology, Beijing Normal University-Hongkong Baptist University United International College, China
| | - Hailun Peng
- Department of Neurology Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders. Chongqing Key Laboratory of Pediatrics, China.,Department of Radiology, Children's Hospital of Chongqing Medical University, China
| | - Ling He
- Department of Neurology Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders. Chongqing Key Laboratory of Pediatrics, China.,Department of Radiology, Children's Hospital of Chongqing Medical University, China
| | - Yue Hu
- Department of Neurology Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders. Chongqing Key Laboratory of Pediatrics, China
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21
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Mergen S, Long B, Matlock A. Posterior Reversible Encephalopathy Syndrome: A Narrative Review for Emergency Clinicians. J Emerg Med 2021; 61:666-673. [PMID: 34696929 DOI: 10.1016/j.jemermed.2021.09.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 09/05/2021] [Accepted: 09/11/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Posterior reversible encephalopathy syndrome (PRES) is a clinicoradiologic disorder characterized by seizures, headache, altered mental status, and visual disturbances, and is often associated with acute hypertension. OBJECTIVE This narrative review provides a focused description of the presentation, diagnostic evaluation, and management of PRES. DISCUSSION PRES is associated with a variety of factors, including acute rise in blood pressure, renal disease, preeclampsia/eclampsia, and immunosuppressive therapy. The pathophysiology is theorized to involve dysfunction of cerebral autoregulation leading to vascular leak or endothelial dysfunction resulting in vasogenic edema. In the emergency department (ED), clinical findings suggestive of PRES should prompt diagnostic testing focused on confirming the diagnosis and excluding other conditions that may present similarly. Laboratory studies are primarily useful for excluding alternative diagnoses. Computed tomography (CT) and, in particular, magnetic resonance imaging (MRI) are the recommended neuroimaging modalities for diagnosis. CT and MRI may demonstrate cerebral vasogenic edema, most often in the distribution of the posterior circulation. Treatment involves management of seizures, control of blood pressure if elevated, and treatment of any underlying trigger. CONCLUSION PRES is a neurological disorder that is typically reversible if recognized on presentation and promptly and appropriately managed. This narrative review characterizes this condition for emergency clinicians.
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Affiliation(s)
- Stephanie Mergen
- Department of Emergency Medicine, Brooke Army Medical Center, Fort Sam Houston, Texas
| | - Brit Long
- Department of Emergency Medicine, Brooke Army Medical Center, Fort Sam Houston, Texas
| | - Aaron Matlock
- Department of Emergency Medicine, Brooke Army Medical Center, Fort Sam Houston, Texas
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22
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Holroyd KB, Rubin DB, Vaitkevicius H. Neurologic Complications in Patients with Cancer. Semin Neurol 2021; 41:588-605. [PMID: 34619783 DOI: 10.1055/s-0041-1733788] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Neurologic symptoms are commonly seen in patients with cancer and can be among the most challenging to diagnose and manage. It is often difficult to determine if new neurologic symptoms are secondary to direct effects of a malignant lesion, systemic complications of disease, paraneoplastic disorders, or side effects of cancer treatment itself. However, early diagnosis and treatment of each of these conditions can improve patients' quality of life and long-term functional outcomes. In this review, we describe a systematic approach to the diagnosis of new neurologic symptoms in patients with known malignancy. We have categorized the neurologic complications of cancer through a mechanistic approach, with an emphasis on ascertaining underlying pathophysiology to guide treatment choice. This review focuses on the acute neurologic complications of cancer that require hospital admission.
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Affiliation(s)
| | - Daniel B Rubin
- Department of Neurology, Massachusetts General Hospital, Brigham and Women's Hospital, Boston, Massachusetts
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23
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Trang TM, Chien PC, Dung BT, Thu NTH, Truc NTT, Khang VNC. Adult-onset mitochondrial encephalomyopathy, lactic acidosis and stroke-like episodes (MELAS) syndrome with progressive sensorineural hearing loss: A case report. Radiol Case Rep 2021; 16:1865-1869. [PMID: 34093932 PMCID: PMC8166901 DOI: 10.1016/j.radcr.2021.04.049] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Revised: 04/21/2021] [Accepted: 04/21/2021] [Indexed: 11/30/2022] Open
Abstract
Mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes (MELAS) syndrome is one of the most common maternally inherited mitochondrial disorders, with no specific treatment available. We report a case of a 34-year-old female in whom symptoms of MELAS were initially misdiagnosed as herpes simplex encephalitis (HSE). Her clinical course was marked by an acute episode of consciousness disturbance with newly developed lesions on brain MRI five years after disease onset and followed by progressive sensorineural hearing loss. Brain imaging sequences throughout the seven years of her illness are presented. The final diagnosis of MELAS syndrome was confirmed by m.3243A>G mitochondrial mutation. In conclusion, understanding the overlapping imaging features between MELAS syndrome and other mimickers, such as HSE or ischemic stroke, is crucial to help establish early diagnosis and initiate appropriate treatment.
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Affiliation(s)
- T M Trang
- Deparment of Neurology, University Medical Centre, Ho Chi Minh City, Vietnam
| | - P C Chien
- Deparment of Radiology, University Medical Centre, Ho Chi Minh City, Vietnam
| | - B T Dung
- Deparment of Neurology, University Medical Centre, Ho Chi Minh City, Vietnam
| | - N T H Thu
- Deparment of Neurology, University Medical Centre, Ho Chi Minh City, Vietnam
| | - N T T Truc
- Deparment of Neurology, Hospital 30-4, Ho Chi Minh City, Vietnam
| | - V N C Khang
- Deparment of Neurology, University Medical Centre, Ho Chi Minh City, Vietnam
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Vincristine-Induced Peripheral Neuropathy (VIPN) in Pediatric Tumors: Mechanisms, Risk Factors, Strategies of Prevention and Treatment. Int J Mol Sci 2021; 22:ijms22084112. [PMID: 33923421 PMCID: PMC8073828 DOI: 10.3390/ijms22084112] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 04/06/2021] [Accepted: 04/14/2021] [Indexed: 12/13/2022] Open
Abstract
Vincristine-induced peripheral neurotoxicity (VIPN) is a very common side effect of vincristine chemotherapy among pediatric patients with cancer. Neuropathy may be sensory, motor and/or autonomic, with consequent reduction, delay or discontinuation of vincristine-chemotherapy, but also pain, disability, reduced quality of life of patients and an increase in medical costs. Vincristine acts out its antineoplastic function by altering the normal assembly and disassembly of microtubules, with their consequent mitosis block and death. Vincristine leads to VIPN through a complex mechanism of damage, which occurs not only on the microtubules, but also on the endothelium and the mitochondria of nerve cells. Furthermore, both patient-related risk factors (age, race, ethnicity and genetic polymorphisms) and treatment-related risk factors (dose, time of infusion and drug–drug interactions) are involved in the pathogenesis of VIPN. There is a lack of consensus about the prophylaxis and treatment of VIPN among pediatric oncologic patients, despite several molecules (such as gabapentin, pyridoxine and pyridostigmine, glutamic acid and glutamine) having been already investigated in clinical trials. This review describes the molecular mechanisms of VIPN and analyzes the risk factors and the principal drugs adopted for the prophylaxis and treatment of VIPN in pediatric patients with cancer.
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Tatsumichi T, Tanaka H, Okazaki T, Takahashi K, Suzuki K, Kawakita K, Houchi H, Kuroda Y, Kosaka S. Uterine sarcoma with posterior reversible encephalopathy syndrome associated with pazopanib. J Clin Pharm Ther 2020; 46:223-226. [PMID: 33044009 DOI: 10.1111/jcpt.13261] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 07/29/2020] [Accepted: 08/17/2020] [Indexed: 12/01/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE Our objective is to report on a case of posterior reversible encephalopathy syndrome associated with pazopanib. CASE DESCRIPTION A 64-year-old patient with uterine sarcoma developed PRES 3 days after pazopanib was initiated. After the discontinuation of pazopanib, the symptoms of PRES improved. WHAT IS NEW AND CONCLUSION The first report worldwide to describe a patient with uterine sarcoma experiencing PRES caused by pazopanib. Patients with uterine sarcoma may experience PRES, even in the early phase of pazopanib therapy.
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Affiliation(s)
| | - Hiroaki Tanaka
- Department of Pharmacy, Kagawa University Hospital, Kagawa, Japan
| | - Tomoya Okazaki
- Emergency Medical Centre, Kagawa University Hospital, Kagawa, Japan
| | - Koichi Takahashi
- Department of Pharmacy, Kagawa University Hospital, Kagawa, Japan
| | - Kiyo Suzuki
- Department of Pharmacy, Kagawa University Hospital, Kagawa, Japan
| | - Kenya Kawakita
- Emergency Medical Centre, Kagawa University Hospital, Kagawa, Japan
| | - Hitoshi Houchi
- Tokushima Bunri University Kagawa school of Pharmaceutical Sciences, Kagawa, Japan
| | - Yasuhiro Kuroda
- Emergency Medical Centre, Kagawa University Hospital, Kagawa, Japan
| | - Shinji Kosaka
- Department of Pharmacy, Kagawa University Hospital, Kagawa, Japan
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26
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Jordan B, Margulies A, Cardoso F, Cavaletti G, Haugnes HS, Jahn P, Le Rhun E, Preusser M, Scotté F, Taphoorn MJB, Jordan K. Systemic anticancer therapy-induced peripheral and central neurotoxicity: ESMO-EONS-EANO Clinical Practice Guidelines for diagnosis, prevention, treatment and follow-up. Ann Oncol 2020; 31:1306-1319. [PMID: 32739407 DOI: 10.1016/j.annonc.2020.07.003] [Citation(s) in RCA: 131] [Impact Index Per Article: 32.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 07/06/2020] [Accepted: 07/06/2020] [Indexed: 12/14/2022] Open
Affiliation(s)
- B Jordan
- Department of Neurology, University Hospital of Heidelberg, Heidelberg, Germany
| | - A Margulies
- European Oncology Nursing Society, Brussels, Belgium
| | - F Cardoso
- Breast Unit, Champalimaud Clinical Center/Champalimaud Foundation, Lisbon, Portugal
| | - G Cavaletti
- Experimental Neurology Unit, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - H S Haugnes
- Department of Oncology, University Hospital of North Norway, Tromsoe, Norway; Institute of Medicine, UIT - The Arctic University, Tromsoe, Norway
| | - P Jahn
- University of Halle, Nursing Research Unit, Halle, Germany
| | - E Le Rhun
- University of Lille, Inserm, U-1192, Lille, France; CHU Lille, Neuro-oncology, General and Stereotaxic Neurosurgery Service, Lille, France; Breast Cancer Department, Oscar Lambret Center, Lille cedex, France; Department of Neurology and Clinical Neuroscience Center, University Hospital and University of Zurich, Zurich, Switzerland
| | - M Preusser
- Clinical Division of Oncology, Comprehensive Cancer Center CNS Tumours Unit, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - F Scotté
- Gustave Roussy Cancer Campus, Interdisciplinary Cancer Course Department, Villejuif, France
| | - M J B Taphoorn
- Department of Neurology, Leiden University Medical Center and Department of Neurology, Haaglanden Medical Center, The Hague, The Netherlands
| | - K Jordan
- Department of Medicine V, Hematology, Oncology and Rheumatology, University of Heidelberg, Heidelberg, Germany
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27
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Anderson RC, Patel V, Sheikh-Bahaei N, Liu CSJ, Rajamohan AG, Shiroishi MS, Kim PE, Go JL, Lerner A, Acharya J. Posterior Reversible Encephalopathy Syndrome (PRES): Pathophysiology and Neuro-Imaging. Front Neurol 2020; 11:463. [PMID: 32612567 PMCID: PMC7308488 DOI: 10.3389/fneur.2020.00463] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 04/29/2020] [Indexed: 12/18/2022] Open
Abstract
Posterior reversible encephalopathy syndrome (PRES) represents a unique clinical entity with non-specific clinical symptoms and unique neuroradiological findings. This syndrome may present with a broad range of clinical symptoms from headache and visual disturbances to seizure and altered mentation. Typical imaging findings include posterior-circulation predominant vasogenic edema. Although there are many well-documented diseases associated with PRES, the exact pathophysiologic mechanism has yet to be fully elucidated. Generally accepted theories revolve around disruption of the blood-brain barrier secondary to elevated intracranial pressures or endothelial injury. In this article, we will review the clinical, typical, and atypical radiological features of PRES, as well as the most common theories behind the pathophysiology of PRES. Additionally, we will discuss some of the treatment strategies for PRES related to the underlying disease state.
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Affiliation(s)
- Redmond-Craig Anderson
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Vishal Patel
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Nasim Sheikh-Bahaei
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Chia Shang J Liu
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Anandh G Rajamohan
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Mark S Shiroishi
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Paul E Kim
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - John L Go
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Alexander Lerner
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Jay Acharya
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
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Gandini J, Manto M, Charette N. Delayed Posterior Reversible Leukoencephalopathy Syndrome Triggered by FLOT Chemotherapy. Front Neurol 2020; 10:1405. [PMID: 32082236 PMCID: PMC7002563 DOI: 10.3389/fneur.2019.01405] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Accepted: 12/23/2019] [Indexed: 11/13/2022] Open
Affiliation(s)
- Jordi Gandini
- Department of Neurology, CHU-Charleroi, Charleroi, Belgium
| | - Mario Manto
- Department of Neurology, CHU-Charleroi, Charleroi, Belgium
- Service des Neurosciences, University of Mons, Mons, Belgium
- *Correspondence: Mario Manto
| | - Nicolas Charette
- Department of Gastroenterology, CHU-Charleroi, Charleroi, Belgium
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29
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Abstract
The introduction of targeted agents into modern cancer therapy pursued the goal of molecularly more specific, and thereby more effective and safer, therapies. Paradoxically, however, several toxicities were brought to greater attention, among these not only cardiac but also vascular toxicities. The latter reach far beyond venous thromboembolism and include a broad spectrum of presentations based on the vascular territories and pathomechanisms involved, including abnormal vascular reactivity, acute thrombosis, or accelerated atherosclerosis. This article provides an overview of the most common presentations and their management strategies.
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Affiliation(s)
- Joerg Herrmann
- Department of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN 55902, USA.
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30
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Chanal E, Bouleftour W, Rivoirard R, Bosaki C, Forges F, Jacquin JP, Fournel P, Mery B, Saban-Roche L. [Posterior Reversible Encephalopathy Syndrome (PRES): About 4 cases]. Presse Med 2019; 48:1026-1031. [PMID: 31653541 DOI: 10.1016/j.lpm.2019.08.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 08/01/2019] [Accepted: 08/14/2019] [Indexed: 10/25/2022] Open
Affiliation(s)
- Edouard Chanal
- Institut de cancérologie Lucien-Neuwirth, département d'oncologie médicale, 108, bis avenue Albert-Raimond, 42271 Saint Priest en Jarez, France
| | - Wafa Bouleftour
- Institut de cancérologie Lucien-Neuwirth, département d'oncologie médicale, 108, bis avenue Albert-Raimond, 42271 Saint Priest en Jarez, France.
| | - Romain Rivoirard
- Institut de cancérologie Lucien-Neuwirth, département d'oncologie médicale, 108, bis avenue Albert-Raimond, 42271 Saint Priest en Jarez, France
| | - Claire Bosaki
- Institut de cancérologie Lucien-Neuwirth, département d'oncologie médicale, 108, bis avenue Albert-Raimond, 42271 Saint Priest en Jarez, France
| | - Fabien Forges
- Institut de cancérologie Lucien-Neuwirth, département de pharmacie, 42271 Saint-Priest-en-Jarez, France
| | - Jean-Philippe Jacquin
- Institut de cancérologie Lucien-Neuwirth, département d'oncologie médicale, 108, bis avenue Albert-Raimond, 42271 Saint Priest en Jarez, France
| | - Pierre Fournel
- Institut de cancérologie Lucien-Neuwirth, département d'oncologie médicale, 108, bis avenue Albert-Raimond, 42271 Saint Priest en Jarez, France
| | - Benoite Mery
- Institut de cancérologie Lucien-Neuwirth, département d'oncologie médicale, 108, bis avenue Albert-Raimond, 42271 Saint Priest en Jarez, France
| | - Léa Saban-Roche
- Institut de cancérologie Lucien-Neuwirth, département d'oncologie médicale, 108, bis avenue Albert-Raimond, 42271 Saint Priest en Jarez, France
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31
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Jamelot M, Fontanilles M, Vaschalde Y. [Reversible posterior leukoencephalopathy post-chemotherapy with carboplatin and paclitaxel]. Bull Cancer 2019; 106:1191-1195. [PMID: 31472945 DOI: 10.1016/j.bulcan.2019.06.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 05/08/2019] [Accepted: 06/02/2019] [Indexed: 10/26/2022]
Affiliation(s)
- Mathieu Jamelot
- Centre Henri-Becquerel, oncologie, 1, rue d'Amiens, 76000 Rouen, France; Université de Rouen, faculté de médecine, 22, boulevard Gambetta, 76000 Rouen, France.
| | - Maxime Fontanilles
- Centre Henri-Becquerel, oncologie, 1, rue d'Amiens, 76000 Rouen, France; Université de Rouen, faculté de médecine, 22, boulevard Gambetta, 76000 Rouen, France
| | - Yvan Vaschalde
- Hôpital Jacques-Monod, neurologie, 29, avenue Pierre-Mendès 76290 Montivilliers, France
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32
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Abstract
PURPOSE OF REVIEW Posterior reversible encephalopathy syndrome (PRES) is a clinicoradiological syndrome characterized by acute cerebral endotheliopathy with consecutive disruption of the blood-brain barrier and vasogenic edema. Since its first description in 1996, PRES is increasingly recognized. However, many aspects of this syndrome with its wide spectrum of clinical and radiological features are still incompletely understood. In this review, possible pathophysiological mechanisms, approaches to diagnosis, recent study results on outcome, and future directions of research are described. RECENT FINDINGS Clinical manifestations of PRES include seizures, headache, visual disturbances, altered mental state, and more rarely hemiparesis or aphasia. Vasogenic edema predominantly occurs in the parieto-occipital region, but lesions affecting formerly called 'atypical' regions such as frontal lobe, cerebellum, or basal ganglia are common. If treated early and adequately, that is by removal of the underlying cause, PRES has a favorable prognosis, but neurological residual symptoms and even mortality can occur, particularly in patients with complications such as intracranial hemorrhage. SUMMARY In summary, validated diagnostic criteria and algorithms are warranted to standardize the diagnosis of PRES. This is essential for further research and future prospective studies that should investigate risk factors for unfavorable outcome and identify the roles of imaging features, clinical symptoms, and other biomarkers in predicting outcome.
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Madsen ML, Due H, Ejskjær N, Jensen P, Madsen J, Dybkær K. Aspects of vincristine-induced neuropathy in hematologic malignancies: a systematic review. Cancer Chemother Pharmacol 2019; 84:471-485. [PMID: 31214762 PMCID: PMC6682573 DOI: 10.1007/s00280-019-03884-5] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 06/04/2019] [Indexed: 01/09/2023]
Abstract
PURPOSE Vincristine is widely used as anticancer therapy for a variety of hematological malignancies. The treatment is limited by progressive vincristine-induced neuropathy, possibly including both peripheral sensory and motor nerves, autonomic nervous functions, and the central nervous system. This dose-limiting side-effect can diminish quality of life and, furthermore, cause discontinuation of vincristine treatment. The present review elucidates the current knowledge regarding vincristine-induced neuropathy in hematologic malignancies, focusing on neuropathy assessment, clinical and molecular predictive markers, drug-drug interference, prevention, and treatment. METHODS This review is conducted by a systematic search strategy for the identification of relevant literature in the PubMed and Embase databases. RESULTS No clinical parameters displayed convincing potential as predictors of vincristine-induced neuropathy; however, preexisting neuropathy was consistently reported to be associated with an increased risk of neurotoxicity. In contrast, molecular markers, including polymorphisms in genes involved in the pharmacodynamics and pharmacokinetics of vincristine, displayed great potential as predictive markers of neuropathy incidence and severity. Furthermore, antifungal drugs, such as itraconazole and voriconazole, decrease the metabolism of vincristine and consequently lead to severe neuropathy when co-administered with vincristine, underscoring why fluconazole should be the antifungal drug of choice. CONCLUSION Reports from the 71 included studies clearly emphasize the lack of consistency in neuropathy assessment, grading systems, and reporting, making it difficult to interpret results between studies. Thus, truer clinical and molecular markers could emerge if the consistency of neuropathy detection and reporting increases by the use of conventional standardized neuropathy assessment tools and grading scales.
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Affiliation(s)
- Marie Lindhard Madsen
- Department of Hematology, Aalborg University Hospital, Sdr. Skovvej 15, 9000, Aalborg, Denmark
| | - Hanne Due
- Department of Hematology, Aalborg University Hospital, Sdr. Skovvej 15, 9000, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Sdr. Skovvej 15, 9000, Aalborg, Denmark
| | - Niels Ejskjær
- Department of Clinical Medicine, Aalborg University, Sdr. Skovvej 15, 9000, Aalborg, Denmark.,Steno Diabetes Center North Denmark, Aalborg University Hospital, 9000, Aalborg, Denmark
| | - Paw Jensen
- Department of Hematology, Aalborg University Hospital, Sdr. Skovvej 15, 9000, Aalborg, Denmark.,Clinical Cancer Research Center, Aalborg University Hospital, Sdr. Skovvej 15, 9000, Aalborg, Denmark
| | - Jakob Madsen
- Department of Hematology, Aalborg University Hospital, Sdr. Skovvej 15, 9000, Aalborg, Denmark
| | - Karen Dybkær
- Department of Hematology, Aalborg University Hospital, Sdr. Skovvej 15, 9000, Aalborg, Denmark. .,Department of Clinical Medicine, Aalborg University, Sdr. Skovvej 15, 9000, Aalborg, Denmark. .,Clinical Cancer Research Center, Aalborg University Hospital, Sdr. Skovvej 15, 9000, Aalborg, Denmark.
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Petrykey K, Lippé S, Robaey P, Sultan S, Laniel J, Drouin S, Bertout L, Beaulieu P, St-Onge P, Boulet-Craig A, Rezgui A, Yasui Y, Sapkota Y, Krull KR, Hudson MM, Laverdière C, Sinnett D, Krajinovic M. Influence of genetic factors on long-term treatment related neurocognitive complications, and on anxiety and depression in survivors of childhood acute lymphoblastic leukemia: The Petale study. PLoS One 2019; 14:e0217314. [PMID: 31181069 PMCID: PMC6557490 DOI: 10.1371/journal.pone.0217314] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 05/08/2019] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND A substantial number of survivors of childhood acute lymphoblastic leukemia suffer from treatment-related late adverse effects including neurocognitive impairment. While multiple studies have described neurocognitive outcomes in childhood acute lymphoblastic leukemia (ALL) survivors, relatively few have investigated their association with individual genetic constitution. METHODS To further address this issue, genetic variants located in 99 genes relevant to the effects of anticancer drugs and in 360 genes implicated in nervous system function and predicted to affect protein function, were pooled from whole exome sequencing data of childhood ALL survivors (PETALE cohort) and analyzed for an association with neurocognitive complications, as well as with anxiety and depression. Variants that sustained correction for multiple testing were genotyped in entire cohort (n = 236) and analyzed with same outcomes. RESULTS Common variants in MTR, PPARA, ABCC3, CALML5, CACNB2 and PCDHB10 genes were associated with deficits in neurocognitive tests performance, whereas a variant in SLCO1B1 and EPHA5 genes was associated with anxiety and depression. Majority of associations were modulated by intensity of treatment. Associated variants were further analyzed in an independent SJLIFE cohort of 545 ALL survivors. Two variants, rs1805087 in methionine synthase, MTR and rs58225473 in voltage-dependent calcium channel protein encoding gene, CACNB2 are of particular interest, since associations of borderline significance were found in replication cohort and remain significant in combined discovery and replication groups (OR = 1.5, 95% CI, 1-2.3; p = 0.04 and; OR = 3.7, 95% CI, 1.25-11; p = 0.01, respectively). Variant rs4149056 in SLCO1B1 gene also deserves further attention since previously shown to affect methotrexate clearance and short-term toxicity in ALL patients. CONCLUSIONS Current findings can help understanding of the influence of genetic component on long-term neurocognitive impairment. Further studies are needed to confirm whether identified variants may be useful in identifying survivors at increased risk of these complications.
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Affiliation(s)
- Kateryna Petrykey
- Sainte-Justine University Health Center (SJUHC), Montreal, Quebec, Canada
- Department of Pharmacology and Physiology, Université de Montréal, Montreal, Quebec, Canada
| | - Sarah Lippé
- Sainte-Justine University Health Center (SJUHC), Montreal, Quebec, Canada
- Department of Psychology, Université de Montréal, Montreal, Quebec, Canada
| | - Philippe Robaey
- Sainte-Justine University Health Center (SJUHC), Montreal, Quebec, Canada
- Children’s Hospital of Eastern Ontario, Ottawa, Ontario, Canada
- Department of Psychiatry, Université de Montréal, Montreal, Quebec, Canada
- Department of Psychiatry, University of Ottawa, Ottawa, Ontario, Canada
| | - Serge Sultan
- Sainte-Justine University Health Center (SJUHC), Montreal, Quebec, Canada
- Department of Psychology, Université de Montréal, Montreal, Quebec, Canada
| | - Julie Laniel
- Sainte-Justine University Health Center (SJUHC), Montreal, Quebec, Canada
- Department of Psychology, Université de Montréal, Montreal, Quebec, Canada
| | - Simon Drouin
- Sainte-Justine University Health Center (SJUHC), Montreal, Quebec, Canada
| | - Laurence Bertout
- Sainte-Justine University Health Center (SJUHC), Montreal, Quebec, Canada
| | - Patrick Beaulieu
- Sainte-Justine University Health Center (SJUHC), Montreal, Quebec, Canada
| | - Pascal St-Onge
- Sainte-Justine University Health Center (SJUHC), Montreal, Quebec, Canada
| | - Aubrée Boulet-Craig
- Sainte-Justine University Health Center (SJUHC), Montreal, Quebec, Canada
- Department of Psychology, Université de Montréal, Montreal, Quebec, Canada
| | - Aziz Rezgui
- Sainte-Justine University Health Center (SJUHC), Montreal, Quebec, Canada
| | - Yutaka Yasui
- Epidemiology and Cancer Control Department, St. Jude Children’s Research Hospital, Memphis, TN, United States of America
| | - Yadav Sapkota
- Epidemiology and Cancer Control Department, St. Jude Children’s Research Hospital, Memphis, TN, United States of America
| | - Kevin R. Krull
- Epidemiology and Cancer Control Department, St. Jude Children’s Research Hospital, Memphis, TN, United States of America
| | - Melissa M. Hudson
- Epidemiology and Cancer Control Department, St. Jude Children’s Research Hospital, Memphis, TN, United States of America
- Oncology Department, St. Jude Children’s Research Hospital, Memphis, TN, United States of America
| | - Caroline Laverdière
- Sainte-Justine University Health Center (SJUHC), Montreal, Quebec, Canada
- Department of Pediatrics, Université de Montréal, Montreal, Quebec, Canada
| | - Daniel Sinnett
- Sainte-Justine University Health Center (SJUHC), Montreal, Quebec, Canada
- Department of Pediatrics, Université de Montréal, Montreal, Quebec, Canada
| | - Maja Krajinovic
- Sainte-Justine University Health Center (SJUHC), Montreal, Quebec, Canada
- Department of Pharmacology and Physiology, Université de Montréal, Montreal, Quebec, Canada
- Department of Pediatrics, Université de Montréal, Montreal, Quebec, Canada
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35
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Anastasopoulou S, Eriksson MA, Heyman M, Wang C, Niinimäki R, Mikkel S, Vaitkevičienė GE, Johannsdottir IM, Myrberg IH, Jonsson OG, Als-Nielsen B, Schmiegelow K, Banerjee J, Harila-Saari A, Ranta S. Posterior reversible encephalopathy syndrome in children with acute lymphoblastic leukemia: Clinical characteristics, risk factors, course, and outcome of disease. Pediatr Blood Cancer 2019; 66:e27594. [PMID: 30592147 DOI: 10.1002/pbc.27594] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 12/04/2018] [Accepted: 12/07/2018] [Indexed: 12/18/2022]
Abstract
BACKGROUND Posterior reversible encephalopathy syndrome (PRES) is a distinct entity with incompletely known predisposing factors. The aim of this study is to describe the incidence, risk factors, clinical course, and outcome of PRES in childhood acute lymphoblastic leukemia (ALL). PROCEDURE Patients aged 1.0 to 17.9 years diagnosed with ALL from July 2008 to December 2015 and treated according to the Nordic Society of Pediatric Hematology and Oncology (NOPHO) ALL2008 protocol were included. Patients with PRES were identified in the prospective NOPHO leukemia toxicity registry, and clinical data were collected from the medical records. RESULTS The study group included 1378 patients, of whom 52 met the criteria for PRES. The cumulative incidence of PRES at one month was 1.7% (95% CI, 1.1-2.5) and at one year 3.7% (95% CI, 2.9-4.9). Older age (hazard ratios [HR] for each one-year increase in age 1.1; 95% CI, 1.0-1.2, P = 0.001) and T-cell immunophenotype (HR, 2.9; 95% CI, 1.6-5.3, P = 0.0005) were associated with PRES. Central nervous system (CNS) involvement (odds ratios [OR] = 2.8; 95% CI, 1.2-6.5, P = 0.015) was associated with early PRES and high-risk block treatment (HR = 2.63; 95% CI, 1.1-6.4, P = 0.033) with late PRES. At follow-up of the PRES patients, seven patients had epilepsy and seven had neurocognitive difficulties. CONCLUSION PRES is a neurotoxicity in the treatment of childhood ALL with both acute and long-term morbidity. Older age, T-cell leukemia, CNS involvement and high-risk block treatment are risk factors for PRES.
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Affiliation(s)
- Stavroula Anastasopoulou
- Department of Women's and Children's Health, Karolinska Institute and Karolinska University Hospital, Stockholm, Sweden
| | - Mats A Eriksson
- Department of Women's and Children's Health, Karolinska Institute and Karolinska University Hospital, Stockholm, Sweden
| | - Mats Heyman
- Department of Women's and Children's Health, Karolinska Institute and Karolinska University Hospital, Stockholm, Sweden
| | - Chen Wang
- Department of Women's and Children's Health, Karolinska Institute and Karolinska University Hospital, Stockholm, Sweden
| | - Riitta Niinimäki
- Oulu University Hospital, Department of Children and Adolescents, and University of Oulu, PEDEGO Research Unit, Oulu, Finland
| | - Sirje Mikkel
- Department of Hematology and Oncology, University of Tartu, Tartu, Estonia
| | - Goda E Vaitkevičienė
- Children's Hospital, affiliation of Vilnius University Hospital Santaros Klinikos and Vilnius University, Vilnius, Lithuania
| | | | - Ida Hed Myrberg
- Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden
| | | | - Bodil Als-Nielsen
- Department of Pediatrics and Adolescent Medicine, University Hospital Rigshospitalet, Copenhagen, and Institute of Clinical Medicine, Faculty of Medicine, University of Copenhagen, Denmark
| | - Kjeld Schmiegelow
- Department of Pediatrics and Adolescent Medicine, University Hospital Rigshospitalet, Copenhagen, and Institute of Clinical Medicine, Faculty of Medicine, University of Copenhagen, Denmark
| | - Joanna Banerjee
- Department of Pediatric Hematology-Oncology and Stem Cell Transplantation, Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Arja Harila-Saari
- Department of Women's and Children's Health, University of Uppsala, Uppsala, Sweden
| | - Susanna Ranta
- Department of Women's and Children's Health, Karolinska Institute and Karolinska University Hospital, Stockholm, Sweden
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Largeau B, Le Tilly O, Sautenet B, Salmon Gandonnière C, Barin-Le Guellec C, Ehrmann S. Arginine Vasopressin and Posterior Reversible Encephalopathy Syndrome Pathophysiology: the Missing Link? Mol Neurobiol 2019; 56:6792-6806. [PMID: 30924075 DOI: 10.1007/s12035-019-1553-y] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2018] [Accepted: 03/13/2019] [Indexed: 12/12/2022]
Abstract
Posterior reversible encephalopathy syndrome (PRES) is a clinicoradiological entity characterized by a typical brain edema. Its pathogenesis is still debated through hypoperfusion and hyperperfusion theories, which have many limitations. As PRES occurs almost exclusively in clinical situations with arginine vasopressin (AVP) hypersecretion, such as eclampsia and sepsis, we hypothesize that AVP plays a central pathophysiologic role. In this review, we discuss the genesis of PRES and its symptoms through this novel approach. We theorize that AVP axis stimulation precipitates PRES development through an increase in AVP secretion or AVP receptor density. Activation of vasopressin V1a receptors leads to cerebral vasoconstriction, causing endothelial dysfunction and cerebral ischemia. This promotes cytotoxic edema through hydromineral transglial flux dysfunction and may increase endothelial permeability, leading to subsequent vasogenic brain edema. If our hypothesis is confirmed, it opens new perspectives for better patient monitoring and therapies targeting the AVP axis in PRES.
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Affiliation(s)
- Bérenger Largeau
- CHRU de Tours, Laboratoire de Biochimie et Biologie Moléculaire, Tours, France.
| | - Olivier Le Tilly
- CHRU de Tours, Laboratoire de Biochimie et Biologie Moléculaire, Tours, France
| | - Bénédicte Sautenet
- Université de Tours, Université de Nantes, INSERM, Methods in patients-centered outcomes and health research (SPHERE) - UMR 1246, CHRU de Tours, Service de Néphrologie-Hypertension artérielle, Dialyses et Transplantation Rénale, Tours, France
| | | | - Chantal Barin-Le Guellec
- Université de Tours, Université de Limoges, INSERM, Individual profiling and prevention of risks with immunosuppressive therapies and transplantation (IPPRITT) - UMR 1248, CHRU de Tours, Laboratoire de Biochimie et Biologie Moléculaire, Tours, France
| | - Stephan Ehrmann
- Université de Tours, INSERM, Centre d'étude des pathologies respiratoires (CEPR) - UMR 1100, CHRU de Tours, Service de Médecine Intensive Réanimation, CIC 1415, réseau CRICS-TRIGGERSEP, Tours, France
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Harrold EC, Peters NM, Williams LJ, Sui JS, McCaffrey JA. Palbociclib-Induced Posterior Reversible Encephalopathy Syndrome: A Previously Unreported Toxicity. J Oncol Pract 2019; 15:119-121. [PMID: 30763200 DOI: 10.1200/jop.18.00643] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Niamh M Peters
- Mater Misericordiae University Hospital, Dublin, Ireland
| | | | - Jane Sy Sui
- Mater Misericordiae University Hospital, Dublin, Ireland
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38
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Simgen A. [White matter alterations after chemotherapy and radiation]. Radiologe 2018; 58:1060-1066. [PMID: 30413853 DOI: 10.1007/s00117-018-0458-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Nowadays chemotherapy and radiotherapy are fundamental therapy concepts in the guidelines of malignant tumors of the central nervous system. Both therapy concepts can cause neurological symptoms or white matter alterations can occur, which can be classified into acute, subacute and chronic. Both symptoms and white matter alterations during acute and subacute phases are in most cases completely reversible, whereas chronic white matter alterations can lead to severe neurological limitations and further impair the quality of life of cancer patients.
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Affiliation(s)
- A Simgen
- Klinik für Diagnostische und Interventionelle Neuroradiologie, Universitätsklinikum des Saarlandes, Kirrberger Str. 1, 66424, Homburg/Saar, Deutschland.
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Mustafa KN, Qasem U, Al-Ryalat NT, Bsisu IK. Rituximab-associated posterior reversible encephalopathy syndrome. Int J Rheum Dis 2018; 22:160-165. [PMID: 30398015 DOI: 10.1111/1756-185x.13427] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Revised: 04/26/2018] [Accepted: 09/28/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Khader N Mustafa
- Division of Rheumatology, Department of Internal Medicine, Jordan University Hospital, University of Jordan, Amman, Jordan
| | - Ula Qasem
- Division of Rheumatology, Department of Internal Medicine, Jordan University Hospital, University of Jordan, Amman, Jordan
| | - Nosaiba T Al-Ryalat
- Department of Radiology, Jordan University Hospital, University of Jordan, Amman, Jordan
| | - Isam K Bsisu
- School of Medicine, Jordan University Hospital, University of Jordan, Amman, Jordan
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40
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Smets GJ, Loyson T, Van Paesschen W, Demaerel P, Nackaerts K. Posterior reversible encephalopathy syndrome possibly induced by pemetrexed maintenance therapy for lung cancer: a case report and literature review. Acta Clin Belg 2018; 73:382-388. [PMID: 29173113 DOI: 10.1080/17843286.2017.1403103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Introduction Advances in systemic chemotherapy, molecular targeted therapy and immunotherapy have extended and improved the quality of life of patients with cancer. However, the central nervous system is very susceptible to complications of systemic cancer and its treatment. Posterior reversible encephalopathy syndrome (PRES) is a rare clinical and neuroradiologic entity which has garnered increasing recognition in the past two decades. Cancer patients are generally treated with cytotoxic agents, immunotherapy, molecular targeted therapies or glucosteroids which are more frequently associated with PRES. Case presentation A 59-year old female, known with a relapse of her lung adenocarcinoma, had been treated with 4 cycles of cisplatin (75 mg/m²) and pemetrexed (500 mg/m²). Six weeks after this combination chemotherapy and within 28 h after the administration of pemetrexed maintenance therapy, she developed a generalised epileptic insult. Magnetic resonance imaging (MRI) of the brain showed bilateral areas of increased signal intensity in the subcortical parietal and frontal white matter. She was treated with a broad spectrum antiseizure drug, levetiracetam 750 mg twice daily and strict control of blood pressure. Discussion Diagnosis of PRES should be considered in all patients with neurologic symptoms who are at risk to develop PRES. It is crucial to establish the diagnosis as soon as possible since there is no specific treatment of PRES other than correction of the underlying risk factors and preventing seizure recurrence. Administration of pemetrexed is a possible risk factor for the development of PRES.
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Affiliation(s)
- Gert-Jan Smets
- Clinical Department of Pneumology, University Hospitals Leuven, University of Leuven, Leuven, Belgium
| | - Tine Loyson
- Clinical Department of Oncology, University Hospitals Leuven, University of Leuven, Leuven, Belgium
| | - Wim Van Paesschen
- Clinical Department of Neurology, University Hospitals Leuven, University of Leuven, Leuven, Belgium
| | - Philippe Demaerel
- Clinical Department of Radiology, University Hospitals Leuven, University of Leuven, Leuven, Belgium
| | - Kristiaan Nackaerts
- Clinical Department of Pneumology, University Hospitals Leuven, University of Leuven, Leuven, Belgium
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Abughanimeh O, Abu Ghanimeh M, Qasrawi A, Al Momani LA, Madhusudhana S. Trastuzumab-associated Posterior Reversible Encephalopathy Syndrome. Cureus 2018; 10:e2686. [PMID: 30050741 PMCID: PMC6059531 DOI: 10.7759/cureus.2686] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Accepted: 05/24/2018] [Indexed: 12/02/2022] Open
Abstract
Posterior reversible encephalopathy syndrome (PRES) is a clinical-radiographic syndrome that presents with neurological manifestations, including seizures, headache, or confusion, and is associated with posterior cerebral white matter edema on imaging. PRES is typically a benign and reversible condition. However, PRES can be fatal or associated with permanent deficits. Numerous conditions are associated with PRES, including hypertensive encephalopathy, renal diseases, and cytotoxic or immunosuppressant drugs. Recently, many case reports described the association between PRES and chemotherapeutic agents. However, trastuzumab-associated PRES is rarely reported. Herein, we report a case of a 51-year-old female with a history of metastatic gastric cancer who developed seizures while being treated with trastuzumab, and neuroimaging confirmed the diagnosis of PRES.
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Affiliation(s)
- Omar Abughanimeh
- Department of Internal Medicine, University of Missouri Kansas City School of Medicine, Kansas City, USA
| | - Mouhanna Abu Ghanimeh
- Department of Internal Medicine-Gastroenterology, Henry Ford Health System, DETROIT, USA
| | - Ayman Qasrawi
- Department of Internal Medicine, University of Missouri Kansas City School of Medicine, Kansas City, USA
| | | | - Sheshadri Madhusudhana
- Hematology and Oncology, University of Missouri Kansas City School of Medicine, Kansas City, USA
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Musioł K, Waz S, Boroń M, Kwiatek M, Machnikowska-Sokołowska M, Gruszczyńska K, Sobol-Milejska G. PRES in the course of hemato-oncological treatment in children. Childs Nerv Syst 2018; 34:691-699. [PMID: 29198072 PMCID: PMC5856901 DOI: 10.1007/s00381-017-3664-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2017] [Accepted: 11/14/2017] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Posterior reversible leukoencephalopathy syndrome (PRES) is a clinical syndrome of varying aetiologies, characterised by acute neurological symptoms of brain dysfunction with MRI abnormalities in posterior cerebral white and grey matter. In most cases, symptoms resolve without neurological consequences. AIM The aim of this paper is the analysis of predisposing factors, clinical outcomes and radiological features of PRES in eight children with hemato-oncological disease. MATERIAL AND METHODS We analysed the medical records of eight hemato-oncological patients aged from 3.0 to 16.1 years. The mean of age at primary diagnosis was 8.5 years. RESULTS All patients had both clinical and radiological PRES features. Seven out of eight underwent intensive chemotherapy regimens. Time elapsed from start of treatment to the occurrence of PRES ranged from 6 to 556 days. In one case, PRES occurred before chemotherapy and was the first symptom of cancer. Most (six of eight) patients had history of hypertension (> 95pc) and some (two of eight) occurred electrolyte imbalance-mainly hypomagnesaemia. Patients presented headache (seven of eight), disturbances of consciousness (six of eight), seizures (six of eight), visual changes (four of eight) and vomiting (three of eight). MRI demonstrated abnormalities in seven children: typical cerebral oedema in the white matter of the occipital to the parietal lobes. Most patient lesions in the MRI shrunk after 4 weeks, and clinical symptoms of PRES disappeared completely within a few hours to few days. CONCLUSION PRES may complicate oncological treatment in children. Hypertension is the most important risk factor of PRES. PRES should be included in differential diagnosis in all patients with acute neurological symptoms.
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Affiliation(s)
- Katarzyna Musioł
- Department of Pediatric Oncology, Hematology and Chemotherapy, Medical University of Silesia, Upper Silesia Children's Care Health Centre, 16 Medykow Str, 40-752, Katowice, Poland.
| | - Sylwia Waz
- Department of Pediatric Oncology, Hematology and Chemotherapy, Medical University of Silesia, Upper Silesia Children's Care Health Centre, 16 Medykow Str, 40-752, Katowice, Poland
| | - Michał Boroń
- Department of Pediatric Oncology, Hematology and Chemotherapy, Medical University of Silesia, Upper Silesia Children's Care Health Centre, 16 Medykow Str, 40-752, Katowice, Poland
| | - Magdalena Kwiatek
- Department of Pediatric Oncology, Hematology and Chemotherapy, Medical University of Silesia, Upper Silesia Children's Care Health Centre, 16 Medykow Str, 40-752, Katowice, Poland
| | | | - Katarzyna Gruszczyńska
- Department of Diagnostic Imaging, Medical University of Silesia, Upper Silesia Children's Care Health Centre, Katowice, Poland
| | - Grażyna Sobol-Milejska
- Department of Pediatric Oncology, Hematology and Chemotherapy, Medical University of Silesia, Upper Silesia Children's Care Health Centre, 16 Medykow Str, 40-752, Katowice, Poland
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Abughanimeh OK, Qasrawi AH, Tahboub MY, Abu Ghanimeh MK. Posterior reversible encephalopathy syndrome while receiving irinotecan with fluorouracil and folinic acid for metastatic gastric cancer. BJR Case Rep 2018; 4:20170033. [PMID: 30363210 PMCID: PMC6159153 DOI: 10.1259/bjrcr.20170033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 09/02/2017] [Accepted: 09/20/2017] [Indexed: 11/13/2022] Open
Abstract
Posterior reversible encephalopathy syndrome (PRES) is a clinical-radiographic syndrome with seizures, headache, altered mental status and visual disturbances. It is typically associated with posterior cerebral white matter oedema on neuroimaging. There is an increasing number of cases of PRES reported with different chemotherapeutic protocols. However, PRES is rarely reported in association with irinotecan, fluorouracil and folinic acid (FOLFIRI). We report a 28-year-old female patient with a history of Stage IV gastric cancer who presented with abdominal pain and recurrent vomiting that was thought to be related to a partial intestinal obstruction secondary to peritoneal metastasis. Eventually, she was treated with FOLFIRI. A few hours after initiation of the fluorouracil infusion in the second cycle, she developed a tonic-clonic seizure. MRI of the brain showed multiple bilateral T2 and flair hyperintense cortical and subcortical lesions suggestive of PRES. Other causes of PRES were excluded, as well as brain metastasis. Unfortunately, the patient developed septic shock and died a few days after her presentation.
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Affiliation(s)
- Omar K Abughanimeh
- Department of Internal medicine, University of Missouri-Kansas City School of Medicine - Graduate Medical Education, Kansas City, MO, USA
| | - Ayman H Qasrawi
- Department of Internal medicine, University of Missouri-Kansas City School of Medicine - Graduate Medical Education, Kansas City, MO, USA
| | - Mohammad Y Tahboub
- Department of Internal medicine, University of Missouri-Kansas City School of Medicine - Graduate Medical Education, Kansas City, MO, USA
| | - Mouhanna K Abu Ghanimeh
- Department of Internal medicine-Division of gastroenterology, Henry Ford Health System, Gastroenterology, Detroit, MI, USA
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44
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Shah RR. Anti-Angiogenic Tyrosine Kinase Inhibitors and Reversible Posterior Leukoencephalopathy Syndrome: Could Hypomagnesaemia Be the Trigger? Drug Saf 2017; 40:373-386. [PMID: 28181126 DOI: 10.1007/s40264-017-0508-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Reversible posterior leukoencephalopathy syndrome (RPLS), also known frequently as posterior reversible encephalopathy syndrome (PRES), is a characteristic acute neuro-radiology syndrome with clinical presentation that typically includes acute hypertension, seizures and other neurological symptoms and signs. Many patients with RPLS have (a history of) pre-existing hypertension and in receipt of diuretics. It is being diagnosed more frequently and in association with an increasing number of morbidities and medications. Drugs most frequently implicated are immunosuppressant drugs and anticancer agents, including a number of anti-angiogenic tyrosine kinase inhibitors (TKIs). Hypomagnesaemia is a frequent finding at presentation in RPLS patients, which is known to lead to or aggravate hypertension. Pre-eclampsia, a variant of RPLS, responds effectively to intravenous magnesium. Cyclosporin, tacrolimus and some TKIs that induce RPLS are also known to give rise to both hypertension and hypomagnesaemia. This raises an interesting hypothesis that hypomagnesaemia may play a contributory role in triggering RPLS in some patients by acutely raising the blood pressure further. Additional systematic studies are required to test this hypothesis. If the hypothesis is confirmed, hypomagnesaemia offers an effective target for risk mitigation and prevention of RPLS in patients identified at risk.
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Affiliation(s)
- Rashmi R Shah
- Pharmaceutical Consultant, 8 Birchdale, Gerrards Cross, Buckinghamshire, UK.
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45
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Makranz C, Khutsurauli S, Kalish Y, Eliahou R, Kadouri L, Gomori JM, Lossos A. Neurological variability in chemotherapy-induced posterior reversible encephalopathy syndrome associated with thrombotic microangiopathy: Case reports and literature review. Mol Clin Oncol 2017; 8:178-182. [PMID: 29387412 DOI: 10.3892/mco.2017.1476] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 09/08/2017] [Indexed: 11/05/2022] Open
Abstract
Posterior reversible encephalopathy syndrome (PRES) is a clinical syndrome characterized by headaches, seizures, a confusional state and visual disturbances associated with transient predominantly bilateral posterior white mater magnetic resonance imaging lesions. It is primarily reported in the setting of hypertension, acute renal failure, peripartum eclampsia, autoimmune disease, immunosuppression and chemotherapy. Thrombotic microangiopathy (TMA), including hemolytic uremic syndrome (HUS) and thrombotic thrombocytopenic purpura (TTP) has also been reported as potential PRES inducer. The present study reviews two cases of patients with PRES, associated with TMA caused by chemotherapy. Their clinical and imaging data, and the relevant literature were reviewed. Patient 1 presented with TMA-induced PRES following mitomycin-C for metastatic colon adenocarcinoma. Treatment with steroids, plasma exchange, intravenous immunoglobulins, aspirin, antihypertensive drugs, and diuretics resulted in resolution of the neurological and imaging deficits. Patient 2 presented with TMA-induced PRES following gemcitabine for metastatic breast carcinoma. Treatment was ineffective and the patient deteriorated despite verapamil, dexamethasone, and plasma exchange. In this report, the relevant literature regarding pathogenesis, treatment and prognosis of chemotherapy-induced PRES associated with TMA was reviewed. We conclude that several chemotherapy agents may cause PRES through various pathogenic mechanisms, leading to clinical variability and divergent response to therapy.
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Affiliation(s)
- Chen Makranz
- Department of Oncology and Neurology, Leslie and Michael Gaffin Center for Neuro-Oncology, Hadassah-Hebrew University Medical Center, Jerusalem 91120, Israel
| | - Salome Khutsurauli
- Department of Oncology, Sharet Institute for Oncology, Hadassah-Hebrew University Medical Center, Jerusalem 91120, Israel
| | - Yosef Kalish
- Department of Hematology, Sharet Institute for Oncology, Hadassah-Hebrew University Medical Center, Jerusalem 91120, Israel
| | - Ruth Eliahou
- Department of Radiology, Sharet Institute for Oncology, Hadassah-Hebrew University Medical Center, Jerusalem 91120, Israel
| | - Luna Kadouri
- Department of Oncology, Sharet Institute for Oncology, Hadassah-Hebrew University Medical Center, Jerusalem 91120, Israel
| | - John Moshe Gomori
- Department of Radiology, Sharet Institute for Oncology, Hadassah-Hebrew University Medical Center, Jerusalem 91120, Israel
| | - Alexander Lossos
- Department of Oncology and Neurology, Leslie and Michael Gaffin Center for Neuro-Oncology, Hadassah-Hebrew University Medical Center, Jerusalem 91120, Israel
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Zekić T, Benić MS, Antulov R, Antončić I, Novak S. The multifactorial origin of posterior reversible encephalopathy syndrome in cyclophosphamide-treated lupus patients. Rheumatol Int 2017; 37:2105-2114. [PMID: 29043491 DOI: 10.1007/s00296-017-3843-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Accepted: 10/03/2017] [Indexed: 01/13/2023]
Abstract
The cyclophosphamide as a predisposing factor for Posterior Reversible Encephalopathy Syndrome (PRES) and therapeutic option for systemic lupus erythematosus (SLE) is still confusing. The first and only case of PRES, probably induced by cyclophosphamide, in Croatia followed by the findings of 36 SLE patients diagnosed with PRES after treatment with cyclophosphamide worldwide are described. An 18-year-old Caucasian female patient with a 1-year history of SLE was admitted to the hospital due to lupus nephritis and acute arthritis. After the second dose of cyclophosphamide was administered, according to the Euro-lupus protocol, the patient presented with a grand mal status epilepticus. The differential diagnosis of neurolupus, cerebrovascular insult, and infection were excluded. The MRI findings showed brain changes in corresponding to PRES. The treatment consisted of antihypertensives, antiepileptics, antiedema therapy, mechanical ventilation, and avoiding further cyclophosphamide use. A Naranjo Adverse Drug Reaction Probability Scale total score of five and a probable reaction related to drug therapy (cyclophosphamide, PRES) was confirmed. In this systematic review, along with cyclophosphamide use, the main predisposing factors involved in PRES occurrence in SLE patients were active SLE and renal involvement. Due to the high number of simultaneously involved predisposing factors (max. six) and their overlapping effect, it is still not possible to clearly establish the role of every factor on PRES onset. The use of cyclophosphamide, as a contributing factor for PRES onset, should be carefully assessed, based on clinicians' experience and knowledge, in the setting of active SLE.
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Affiliation(s)
- Tatjana Zekić
- Department of Rheumatology and Clinical Immunology, Clinical Hospital Centre Rijeka, Krešimirova 42, 51000, Rijeka, Croatia.
| | - Mirjana Stanić Benić
- Department of Clinical Pharmacology, Clinical Hospital Centre Rijeka, Krešimirova 42, 51000, Rijeka, Croatia.
| | - Ronald Antulov
- Department of Radiology, Sydvestjyisk Sygehus, Esbjerg, Denmark
| | - Igor Antončić
- Department of Neurology, Clinical Hospital Centre Rijeka, Rijeka, Croatia
- University of Rijeka Medical School, Rijeka, Croatia
| | - Srđan Novak
- Department of Rheumatology and Clinical Immunology, Clinical Hospital Centre Rijeka, Krešimirova 42, 51000, Rijeka, Croatia
- University of Rijeka Medical School, Rijeka, Croatia
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Miaris N, Sgouros J, Gerolympou M, Spyropoulos B, Drakopoulos D, Gkoura S, Res H, Samantas E. Posterior Reversible Encephalopathy Syndrome During Treatment with Aflibercept, 5-Fluorouracil, Leucovorin, and Irinotecan for Metastatic Colorectal Cancer. J Gastrointest Cancer 2017; 50:123-126. [PMID: 28660523 DOI: 10.1007/s12029-017-9986-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Nikolaos Miaris
- Third Department of Medical Oncology, 'Agioi Anargyroi' General Oncology Hospital of Kifisia, Noufaron and Timiou Stavrou 14, N. Kifisia, 14564, Athens, Greece.
| | - Joseph Sgouros
- Third Department of Medical Oncology, 'Agioi Anargyroi' General Oncology Hospital of Kifisia, Noufaron and Timiou Stavrou 14, N. Kifisia, 14564, Athens, Greece
| | - Margarita Gerolympou
- Third Department of Medical Oncology, 'Agioi Anargyroi' General Oncology Hospital of Kifisia, Noufaron and Timiou Stavrou 14, N. Kifisia, 14564, Athens, Greece
| | - Basilios Spyropoulos
- First Department of Internal Medicine, 401 General Military Hospital of Athens, Athens, Greece
| | | | - Stefania Gkoura
- Third Department of Medical Oncology, 'Agioi Anargyroi' General Oncology Hospital of Kifisia, Noufaron and Timiou Stavrou 14, N. Kifisia, 14564, Athens, Greece
| | - Helen Res
- Third Department of Medical Oncology, 'Agioi Anargyroi' General Oncology Hospital of Kifisia, Noufaron and Timiou Stavrou 14, N. Kifisia, 14564, Athens, Greece
| | - Epaminondas Samantas
- Third Department of Medical Oncology, 'Agioi Anargyroi' General Oncology Hospital of Kifisia, Noufaron and Timiou Stavrou 14, N. Kifisia, 14564, Athens, Greece
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48
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Immune system activation in the pathogenesis of posterior reversible encephalopathy syndrome. Brain Res Bull 2017; 131:93-99. [PMID: 28373149 DOI: 10.1016/j.brainresbull.2017.03.012] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Revised: 03/24/2017] [Accepted: 03/29/2017] [Indexed: 11/21/2022]
Abstract
Posterior reversible encephalopathy syndrome (PRES) is a clinical-radiological syndrome characterized by a variable combination of headaches, seizures, altered mental status, visual impairment, focal neurological signs and symmetric vasogenic edema in bilateral posterior cerebral circulation territory. The pathogenesis of PRES is still controversial. Most of the clinical conditions associated with PRES involve a systemic toxicity response in the entire organism with activation of the cells of the immune system and cytokines. These PRES related conditions induce T cell activation, cytokine release, and subsequent leukocyte adhesion and activation, resulting in endothelial damage and fluid leakage. This potential mechanism of immune system activation and endothelial dysfunction may play a critical role in the pathogenesis of PRES. In this review, the role of immune system activation and endothelial dysfunction in the pathogenesis of PRES is discussed, with the aim to improve our understanding of this disorder.
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