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Zhang W, Wang Y, Jiang X, Zhao H, Jia X, Wang Q, Chen Y, Jiang Y, Ma Z, Chang L, Wang X. Newly identified adverse events for gemcitabine using the Food and Drug Administration Adverse Event Reporting System. Expert Opin Drug Saf 2024; 23:917-923. [PMID: 37974405 DOI: 10.1080/14740338.2023.2284989] [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: 09/07/2023] [Accepted: 10/31/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND Our research aimed to identify previously undocumented adverse events (AEs) in the gemcitabine drug insert with the goal of informing clinical practice. METHODS We extracted adverse events associated with gemcitabine use through 2023 using the Food and Drug Administration Adverse Event Reporting System (FAERS) database. Four algorithms (Reporting Odds Ratio, Proportional Reporting Ratio, Bayesian Confidence Propagation Neural Network, and Empirical Bayesian Geometric Mean) were employed to detect new AE signals. AEs were considered positive signals only if they were detected by all four algorithms. RESULTS From 2014 to 2023, a total of 42,360 AEs were reported in 14,905 individuals following gemcitabine use. These AEs totaled 437 preferred terms (PTs) across 20 system organ classes (SOCs). We identified unexpected AEs related to the ocular disorders, the nervous system, and the ear and the labyrinth. The ocular organ system will present with retinopathy, purtscher retinopathy, choroidal effusion, amaurosis, necrotizing scleritis, etc. The nervous system may experience reversible posterior encephalopathy syndrome, cerebellar syndrome, cauda equina syndrome, athetosis, transverse myelitis, etc. The ears and labyrinth may exhibit ototoxicity. CONCLUSION Our study identified previously undetected signals following gemcitabine treatment, thereby providing new insights for future medication guidance.
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Affiliation(s)
- Wei Zhang
- Department of Urology, First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Yuhong Wang
- Shanxi Medical Service Evaluation Center, Department of health management, Taiyuan, Shanxi, China
| | - Xin Jiang
- Department of Urology, First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Hu Zhao
- Department of Urology, First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Xinli Jia
- Department of Urology, First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Qiye Wang
- Department of Urology, First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Yue Chen
- Department of Urology, First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Yuanfang Jiang
- Department of Urology, First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Zhifang Ma
- Department of Urology, First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Lina Chang
- Shanxi Provincial Hospital of Traditional Chinese Medicine, Department of Physician Standardization Training Center, Taiyuan, Shanxi, China
| | - Xin Wang
- Department of Urology, First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
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Jha VK, Akal RS, Mahapatra D, Sharma A, Singh BP, Arora R. Nephrotic Syndrome and Posterior Reversible Encephalopathy Syndrome as Clinical Presentations of Gemcitabine-Induced Thrombotic Micro-Angiopathy. Indian J Nephrol 2024; 34:74-78. [PMID: 38645915 PMCID: PMC11003583 DOI: 10.4103/ijn.ijn_277_22] [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: 08/14/2022] [Accepted: 09/18/2022] [Indexed: 04/23/2024] Open
Abstract
Gemcitabine-induced thrombotic micro-angiopathy (GiTMA) is a very rare pathology of micro-vascular occlusion with a poor prognosis. In this case report, we present a young male with pancreatic carcinoma who received gemcitabine as adjuvant chemotherapy and developed thrombotic micro-angiopathy (TMA) manifesting as nephrotic syndrome with renal dysfunction and posterior reversible encephalopathy syndrome (PRES). The case was successfully managed with discontinuation of the drug and conservative management. The pathogenesis of GiTMA might be direct endothelial dysfunction with consequent activation of the clotting system. The role of plasma exchanges and monoclonal antibodies is unclear in drug-induced TMA.
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Affiliation(s)
- Vijoy Kumar Jha
- Department of Nephrology, Command Hospital Air Force, Bengaluru, Karnataka, India
| | - Ramanjit Singh Akal
- Department of Nephrology, Command Hospital Air Force, Bengaluru, Karnataka, India
| | - Debasish Mahapatra
- Department of Nephrology, Command Hospital Air Force, Bengaluru, Karnataka, India
| | - Alok Sharma
- Department of Renal Pathology and Electron Microscopy, Lal PathLabs Limited, New Delhi, India
| | - Bhanu Pratap Singh
- Department of Radiology, Command Hospital Air Force, Bengaluru, Karnataka, India
| | - Rahil Arora
- Department of Medicine, Command Hospital Air Force, Bengaluru, Karnataka, India
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Birle V, Dongargaonkar P, Sharma S, Gaiwal A. Posterior reversible encephalopathy syndrome in pregnancy: A case series of 5 cases. MGM JOURNAL OF MEDICAL SCIENCES 2022. [DOI: 10.4103/mgmj.mgmj_30_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Schaub JR, Tang SC. Delayed Gemcitabine-Induced Posterior Reversible Encephalopathy Syndrome. Am J Med Sci 2020; 361:795-798. [PMID: 33888263 DOI: 10.1016/j.amjms.2020.10.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 08/16/2020] [Accepted: 10/29/2020] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Posterior reversible encephalopathy syndrome (PRES) is a rare clinical-radiographic syndrome that has been expanding rapidly in the world of clinical medical oncology and hematology. In this article, we provide a unique patient case of delayed gemcitabine-induced PRES. BRIEF CASE REPORT A 60-year-old African American female with significant past medical history of ER+/PR+/HER2- invasive ductal carcinoma of the left breast is seen in the medical oncology clinic with vague, mild complaints of lightheadedness. She had progressed on multiple lines of chemotherapy and was ultimately switched to gemcitabine. One month after her third dose of gemcitabine, she developed acute vision loss and soon developed generalized tonic-clonic seizure. Extensive workup was unrevealing other than PRES and she slowly improved with supportive care and withdrawal of the medication. DISCUSSION Multiple case reports have described PRES in the context of combination chemotherapy with gemcitabine and a platinum agent in the treatment of gastrointestinal malignancies. With growing evidence, this case is consistent with the hypothesis that gemcitabine as monotherapy has a direct association with PRES. This case highlights a unique aspect in that PRES can occur at a delayed time interval, much further than the expected hours to days after the previous treatment.
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Affiliation(s)
- John R Schaub
- Cancer Center and Research Institute, University of Mississippi Medical Center Guyton Research Building, MS, USA
| | - Shou-Ching Tang
- Cancer Center and Research Institute, University of Mississippi Medical Center Guyton Research Building, MS, USA.
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Posterior reversible encephalopathy syndrome (PRES): Is DWI a prognosis factor? J Clin Neurosci 2019; 72:357-359. [PMID: 31874813 DOI: 10.1016/j.jocn.2019.12.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Accepted: 12/01/2019] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Posterior reversible encephalopathy syndrome is a clinicoradiologic entity with typical MR imaging showing a white matter vasogenic edema predominantly affecting the occipital and parietal lobes of the brain. The aim of this article is evaluated the importance of DWI as a prognosis factor in patients with PRES. MATERIALS AND METHODS We reviewed data from 70 patients with PRES (35 with restricted DWI and 35 with no DWI abnormalities), that were admitted to Hospital São Lucas-PUCRS. These two groups were evaluated in age, sex, previous diseases and past medical history, use of medications, the neurologic manifestations, the highest blood pressure during the neurologic presentation and the highest creatinine during the period of observation. RESULTS Evaluating 70 patients with PRES with a mean age of 25.4 years old (range from 2 to 74 years old; 55 female and 15 male) we identified 35 cases were brain MRI presents with restricted DWI. Restricted DWI was associated with higher mortality in 90 days (14.2% vs 0.0%; p: 0.027). CONCLUSIONS Few articles present new data that will help clinicians in therapeutic decisions or that modify the knowledge of this syndrome. We suggested that restricted DWI is associated with a worst prognosis in PRES.
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Wang Q, Huang B, Shen G, Zeng Y, Chen Z, Lu C, Lerner A, Gao B. Blood-Brain Barrier Disruption as a Potential Target for Therapy in Posterior Reversible Encephalopathy Syndrome: Evidence From Multimodal MRI in Rats. Front Neurol 2019; 10:1211. [PMID: 31849806 PMCID: PMC6901929 DOI: 10.3389/fneur.2019.01211] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 10/30/2019] [Indexed: 12/16/2022] Open
Abstract
Background: To explore blood-brain barrier disruption in hypertensive posterior reversible encephalopathy syndrome. Methods: The hypertension rat models were successfully established and scanned on 7T micro-MRI. MRI parameter maps including apparent diffusion coefficient, T1 value, and perfusion metrics such as cerebral blood volume, cerebral blood flow, mean transit time and time to peak maps, were calculated. Results: The ADC values of the experimental group were higher than those of the control group both in cortical (P < 0.01) and subcortical (P < 0.05) regions. Voxel-wise analysis of ADC maps localized vasogenic edema primarily to the posterior portion of the brain. The increase in cerebral blood volume and cerebral blood flow values were found in the cortical and subcortical regions of rats with acute hypertension. No correlation was found between perfusion metrics and mean arterial pressure. The Evans blue dye content was higher in the posterior brain region than the anterior one (P < 0.05). Conclusions: Cerebral vasogenic edema resulting from acute hypertension supports the hypothesis of posterior reversible encephalopathy syndrome as the result of blood-brain barrier disruption, which maybe the potential therapeutic target for intervention.
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Affiliation(s)
- Quanlai Wang
- Department of Imaging, Zhoukou Central Hospital, Zhoukou, China.,Department of Radiology, Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Bin Huang
- Department of Radiology, Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Guiquan Shen
- Department of Radiology, Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Yu Zeng
- Department of Radiology, Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Zheng Chen
- Department of Radiology, Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Chunqiang Lu
- Jiangsu Key Laboratory of Molecular and Functional Imaging, Southeast University, Nanjing, China
| | - Alexander Lerner
- Division of Neuroradiology, Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Bo Gao
- Department of Radiology, Affiliated Hospital of Guizhou Medical University, Guiyang, China
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Phase I dose-escalation study of copanlisib in combination with gemcitabine or cisplatin plus gemcitabine in patients with advanced cancer. Br J Cancer 2018; 118:462-470. [PMID: 29348486 PMCID: PMC5830590 DOI: 10.1038/bjc.2017.428] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Revised: 11/02/2017] [Accepted: 11/07/2017] [Indexed: 12/19/2022] Open
Abstract
Background: Copanlisib is a pan-class I phosphatidylinositol 3-kinase (PI3K) inhibitor with predominant PI3K-α/δ activity that has demonstrated clinical activity and manageable safety when administered as monotherapy in a phase II study. Combination therapy may overcome compensatory signalling that could occur with PI3K pathway inhibition, resulting in enhanced inhibitory activity, and preclinical studies of copanlisib with gemcitabine have demonstrated potent anti-tumour activity in vivo. Methods: A phase I, open-label, dose-escalation study to evaluate the safety, tolerability and recommended phase II dose (RP2D) of copanlisib with gemcitabine or with cisplatin plus gemcitabine (CisGem) in patients with advanced malignancies, including an expansion cohort in patients with biliary tract cancer (BTC) at the RP2D of copanlisib plus CisGem. Copanlisib and gemcitabine were administered on days 1, 8 and 15 of a 28-day cycle; maximum tolerated dose (MTD) and RP2D of copanlisib were determined. Copanlisib plus CisGem was administered on days 1 and 8 of a 21-day cycle; pharmacokinetics and biomarkers were assessed. Results: Fifty patients received treatment as follows: dose-escalation cohorts, n=16; copanlisib plus CisGem cohort, n=14; and BTC expansion cohort, n=20. Copanlisib 0.8 mg kg−1 plus gemcitabine was the MTD and RP2D for both combinations. Common treatment-emergent adverse events included nausea (86%), hyperglycaemia (80%) and decreased platelet count (80%). Copanlisib exposure displayed a dose-proportional increase. No differences were observed upon co-administration of CisGem. Response rates were as follows: copanlisib plus gemcitabine, 6.3% (one partial response in a patient with peritoneal carcinoma); copanlisib plus CisGem, 12% (one complete response and three partial responses all in patients with BTC (response rate 17.4% in patients with BTC)). Mutations were detected in PIK3CA (1 out of 43), KRAS (10 out of 43) and BRAF (2 out of 22), with phosphate and tensin homologue protein loss in 41% (12 out of 29). Conclusions: Copanlisib plus CisGem demonstrated a manageable safety profile, favourable pharmacokinetics, and potentially promising clinical response.
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Cutaneous Lymphoma—Inpatient Considerations. CURRENT DERMATOLOGY REPORTS 2017. [DOI: 10.1007/s13671-017-0173-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Chemotherapy-associated Posterior Reversible Encephalopathy Syndrome: A Case Report and Review of the Literature. Neurologist 2017; 21:112-117. [PMID: 27801773 DOI: 10.1097/nrl.0000000000000105] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION There are increasing reports of posterior reversible encephalopathy syndrome (PRES) associated with the use of chemotherapeutic agents. Recognition of PRES is crucial given its reversibility with appropriate supportive management. We report a patient presenting with PRES after treatment with Rituximab, Cyclophosphamide, Hydroxydaunorubicin/Adriamycin, Oncovin/Vincristine, Prednisone (R-CHOP) and intrathecal methotrexate. We also perform a systematic review of the literature on chemotherapy-associated PRES. CASE REPORT A 72-year-old man with recently diagnosed diffuse large B-cell lymphoma became unresponsive 4 days after initiation of R-CHOP and intrathecal methotrexate. Brain magnetic resonance imaging showed interval development of occipital and temporal fluid attenuation inversion recovery hyperintensities consistent with PRES. The patient's blood pressure was aggressively controlled and he received 5 days of high-dose methylprednisone. He subsequently regained consciousness and his mental status gradually improved. Repeat magnetic resonance imaging showed interval resolution of the bilateral fluid attenuation inversion recovery hyperintensities. REVIEW SUMMARY We performed a systematic review of the literature and included a total of 70 unique cases involving chemotherapy-associated PRES. Platinum-containing drugs, Cyclophosphamide, Hydroxydaunorubicin/Adriamycin, Oncovin/Vincristine, Prednisone/R-CHOP regimens, and gemcitabine were the agents most commonly used in patients who developed suspected chemo-associated PRES. Median onset of symptoms occurred 8 days after chemotherapy. Hypertension was the most commonly reported risk factor associated with the development of chemotherapy-associated PRES. In most cases, PRES improved with supportive management alone within 2 weeks. CONCLUSIONS Chemotherapy-associated PRES is an increasingly encountered syndrome. Both neurologists and non-neurologists should be familiar with the most commonly implicated agents, symptoms, risk factors, and clinical course of chemotherapy-associated PRES, given its favorable prognosis with appropriate management.
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Cherniawsky H, Merchant N, Sawyer M, Ho M. A case report of posterior reversible encephalopathy syndrome in a patient receiving gemcitabine and cisplatin. Medicine (Baltimore) 2017; 96:e5850. [PMID: 28225482 PMCID: PMC5569414 DOI: 10.1097/md.0000000000005850] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
RATIONALE Posterior reversible encephalopathy syndrome (PRES) is a subacute syndrome causing characteristic neurologic and radiologic findings. PRES is predominantly caused by malignant hypertension though it has been associated with immunosuppressive treatments such as chemotherapy. PATIENT CONCERNS We describe a case of a 58 year old female who developed fluctuant level of consciousness, agitation. DIAGNOSIS MRI findings were in keeping with posterior reversible encephalopathy syndrome following cycle 6 of palliative gemcitabine and cisplatin therapy for metastatic cholangiocarcinoma. INTERVENTIONS The patient was managed with magnesium supplementation for hypomagnesemia and amlodipine. OUTCOMES The patient's level of consciousness returned to normal though she had residual neurologic deficits impairing her ability to drive and impacting her balance. CONCLUSIONS Cisplatin is a documented causative agent of PRES though gemcitabine is rarely associated with the syndrome. Combination cisplatin and gemcitabine therapy causing radiologically proven PRES has been documented in only 3 previous case reports. Gemcitabine's poor blood-brain barrier penetration makes it an unlikely culprit of central nervous system (CNS) toxicities. Our case and previous reports suggest higher doses may contribute to CNS toxicities such as PRES. Additionally, an emerging trend of hypomagnesemia associated with PRES has been documented inside and outside the context of malignancy and suggests a possible target for treatment and prevention warranting further investigation.
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Affiliation(s)
- Hannah Cherniawsky
- Department of Internal Medicine, University of Alberta, Edmonton, Alberta
| | | | | | - Maria Ho
- Cross Cancer Institute, Edmonton, Alberta, Canada
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Marrone LCP, Martins WA, Borges MT, Rossi BC, Brunelli JPF, Vedana VM, Missima N, Soder RB, Marrone ACH, da Costa JC. Posterior Reversible Encephalopathy Syndrome: Clinical Differences in Patients with Exclusive Involvement of Posterior Circulation Compared to Anterior or Global Involvement. J Stroke Cerebrovasc Dis 2016; 25:1776-1780. [PMID: 27103268 DOI: 10.1016/j.jstrokecerebrovasdis.2016.03.042] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Revised: 03/16/2016] [Accepted: 03/19/2016] [Indexed: 12/22/2022] Open
Abstract
INTRODUCTION Posterior reversible encephalopathy syndrome (PRES) is a clinical-radiologic syndrome not yet fully understood and characterized by transient neurologic symptoms in addition to typical radiological findings. There are only a few articles that describe the clinical differences between patients with PRES that involve carotid and vertebrobasilar circulations. Our study aims to further evaluate the differences between predominantly anterior and posterior circulation PRES. METHODS We review 54 patients who had received the diagnosis of PRES from 2009 to 2015. The patients were divided into 2 groups: (1) exclusively in posterior zones; and (2) anterior plus posterior zones or exclusively anterior zones. Several clinical characteristics were evaluated, including the following: age, sex, previous diseases, the neurologic manifestations, the highest blood pressure in the first 48 hours of presentation, highest creatinine level during symptoms, and the neuroimaging alterations in brain magnetic resonance imaging. RESULTS Mean age at diagnosis was 28.5 years old (9 men and 45 women) and mean systolic blood pressure among patients with lesions only in posterior zones was 162.1 mmHg compared to 179.2 mmHg in the anterior circulation. The most common symptoms in the 2 groups were headache and visual disturbances. DISCUSSION PRES may have several radiological features. A higher blood pressure seems to be 1 of the factors responsible for developing widespread PRES, with involvement of carotid vascular territory. This clinical-radiological difference probably occurs because of the larger number of autonomic receptors in the carotid artery in comparison to the vertebral-basilar system.
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Affiliation(s)
- Luiz Carlos Porcello Marrone
- Neurology Department of Hospital São Lucas and Instituto do Cérebro (Inscer), Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Rio Grande do Sul, Brazil.
| | - William Alves Martins
- Neurology Department of Hospital São Lucas and Instituto do Cérebro (Inscer), Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Rio Grande do Sul, Brazil
| | - Magno Tauceda Borges
- Neurology Department of Hospital São Lucas and Instituto do Cérebro (Inscer), Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Rio Grande do Sul, Brazil
| | - Bruna Carvalho Rossi
- Neurology Department of Hospital São Lucas and Instituto do Cérebro (Inscer), Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Rio Grande do Sul, Brazil
| | - João Pedro Farina Brunelli
- Neurology Department of Hospital São Lucas and Instituto do Cérebro (Inscer), Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Rio Grande do Sul, Brazil
| | - Viviane Maria Vedana
- Neurology Department of Hospital São Lucas and Instituto do Cérebro (Inscer), Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Rio Grande do Sul, Brazil
| | - Nathalia Missima
- Neurology Department of Hospital São Lucas and Instituto do Cérebro (Inscer), Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Rio Grande do Sul, Brazil
| | - Ricardo Bernardi Soder
- Neurology Department of Hospital São Lucas and Instituto do Cérebro (Inscer), Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Rio Grande do Sul, Brazil
| | - Antônio Carlos Huf Marrone
- Neurology Department of Hospital São Lucas and Instituto do Cérebro (Inscer), Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Rio Grande do Sul, Brazil
| | - Jaderson Costa da Costa
- Neurology Department of Hospital São Lucas and Instituto do Cérebro (Inscer), Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Rio Grande do Sul, Brazil
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Marrone LCP, Martins WA, Brunelli JPF, Fussiger H, Carvalhal GF, Filho JRH, Soder RB, Schuck M, Viola FS, Marrone ACH, da Costa JC. PRES with asymptomatic spinal cord involvement. Is this scenario more common than we know? Spinal Cord Ser Cases 2016; 2:15001. [PMID: 28053726 DOI: 10.1038/scsandc.2015.1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Accepted: 05/18/2015] [Indexed: 02/02/2023] Open
Abstract
INTRODUCTION Posterior reversible encephalopathy syndrome (PRES) is an entity characterized by neurologic symptoms such as headaches, altered mental status, seizures and visual changes, and it is associated with white matter vasogenic edema predominantly affecting the posterior occipital and parietal lobes of the brain. CASE REPORT A 19-year-old patient developed PRES after the use of chemotherapy for a testicular teratocarcinoma and after the development of a blood pressure elevation. DISCUSSION Few cases described the involvement of the spinal cord in this syndrome. In the majority of these cases, the spinal cord involvement was asymptomatic or with few symptoms of spinal cord disease.
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Affiliation(s)
- L C P Marrone
- Hospital São Lucas/Instituto do Cérebro-Pontificia Universidade Católicas do Rio Grande do Sul (PUCRS) , Porto Alegre, Brazil
| | - W A Martins
- Hospital São Lucas/Instituto do Cérebro-Pontificia Universidade Católicas do Rio Grande do Sul (PUCRS) , Porto Alegre, Brazil
| | - J P F Brunelli
- Hospital São Lucas/Instituto do Cérebro-Pontificia Universidade Católicas do Rio Grande do Sul (PUCRS) , Porto Alegre, Brazil
| | - H Fussiger
- Hospital São Lucas/Instituto do Cérebro-Pontificia Universidade Católicas do Rio Grande do Sul (PUCRS) , Porto Alegre, Brazil
| | - G F Carvalhal
- Hospital São Lucas/Instituto do Cérebro-Pontificia Universidade Católicas do Rio Grande do Sul (PUCRS) , Porto Alegre, Brazil
| | - J R H Filho
- Hospital São Lucas/Instituto do Cérebro-Pontificia Universidade Católicas do Rio Grande do Sul (PUCRS) , Porto Alegre, Brazil
| | - R B Soder
- Hospital São Lucas/Instituto do Cérebro-Pontificia Universidade Católicas do Rio Grande do Sul (PUCRS) , Porto Alegre, Brazil
| | - M Schuck
- Hospital São Lucas/Instituto do Cérebro-Pontificia Universidade Católicas do Rio Grande do Sul (PUCRS) , Porto Alegre, Brazil
| | - F S Viola
- Hospital São Lucas/Instituto do Cérebro-Pontificia Universidade Católicas do Rio Grande do Sul (PUCRS) , Porto Alegre, Brazil
| | - A C H Marrone
- Hospital São Lucas/Instituto do Cérebro-Pontificia Universidade Católicas do Rio Grande do Sul (PUCRS) , Porto Alegre, Brazil
| | - J C da Costa
- Hospital São Lucas/Instituto do Cérebro-Pontificia Universidade Católicas do Rio Grande do Sul (PUCRS) , Porto Alegre, Brazil
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Chung CG, Poligone B. Other Chemotherapeutic Agents in Cutaneous T-Cell Lymphoma. Dermatol Clin 2015; 33:787-805. [DOI: 10.1016/j.det.2015.05.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Fitzgerald RT, Wright SM, Samant RS, Kumar M, Ramakrishnaiah RH, Van Hemert R, Brown AT, Angtuaco EJ. Elevation of serum lactate dehydrogenase at posterior reversible encephalopathy syndrome onset in chemotherapy-treated cancer patients. J Clin Neurosci 2014; 21:1575-8. [DOI: 10.1016/j.jocn.2014.03.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Revised: 02/25/2014] [Accepted: 03/02/2014] [Indexed: 11/25/2022]
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Porcello Marrone LC, Gadonski G, de Oliveira Laguna G, Poli-de-Figueiredo CE, Pinheiro da Costa BE, Lopes MFT, Brunelli JPF, Diogo LP, Huf Marrone AC, Da Costa JC. Blood-brain barrier breakdown in reduced uterine perfusion pressure: a possible model of posterior reversible encephalopathy syndrome. J Stroke Cerebrovasc Dis 2014; 23:2075-2079. [PMID: 25113078 DOI: 10.1016/j.jstrokecerebrovasdis.2014.03.012] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Revised: 03/05/2014] [Accepted: 03/14/2014] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Posterior reversible encephalopathy syndrome (PRES) is a clinical entity characterized by headaches, altered mental status, seizures, and visual disturbances and is associated with white matter vasogenic edema. There are no experimental models to study PRES brain changes. METHODS Twenty-eight pregnant Wistar rats were divided into 4 groups of 7: (1) pregnant-control; (2) reduced uterine perfusion pressure (RUPP); (3) invasive blood pressure (IBP); and (4) reduced uterine perfusion pressure plus invasive blood pressure (RUPP-IBP). The RUPP and RUPP-IBP groups were submitted to a reduction of uterine perfusion pressure at pregnancy days 13 to 15. The invasive mean arterial pressure of the IBP and RUPP-IBP groups was measured on day 20. The blood-brain barriers (BBBs) of all groups were analyzed using 2% Evans Blue dye on day 21. RESULTS RUPP rats had higher blood pressures and increased BBB permeability to Evans Blue dye compared with the control animals. Brain staining occurred in 11 of 14 RUPP rats and in none of the control groups (P < .0001). CONCLUSIONS The physiopathology of PRES remains unclear. Here, we described the use of RUPP rats as a potential model to better comprehend this syndrome.
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Affiliation(s)
- Luiz Carlos Porcello Marrone
- Neurology Service, Hospital São Lucas and Instituto do Cérebro do Rio Grande do Sul, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS).
| | - Giovani Gadonski
- Nephrology Service, Hospital São Lucas, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS)
| | - Gabriela de Oliveira Laguna
- Neurology Service, Hospital São Lucas and Instituto do Cérebro do Rio Grande do Sul, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS)
| | | | | | | | - João Pedro Farina Brunelli
- Neurology Service, Hospital São Lucas and Instituto do Cérebro do Rio Grande do Sul, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS)
| | - Luciano Passamani Diogo
- Neurology Service, Hospital São Lucas and Instituto do Cérebro do Rio Grande do Sul, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS)
| | - Antônio Carlos Huf Marrone
- Neurology Service, Hospital São Lucas and Instituto do Cérebro do Rio Grande do Sul, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS)
| | - Jaderson Costa Da Costa
- Neurology Service, Hospital São Lucas and Instituto do Cérebro do Rio Grande do Sul, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS)
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Marrone LCP, Gadonski G, Diogo LP, Brunelli JPF, Martins WA, Laguna GDO, Bahlis LF, Filho JRH, da Costa BEP, Poli-de-Figueiredo CE, Marrone ACH, da Costa JC. Posterior reversible encephalopathy syndrome: differences between pregnant and non-pregnant patients. Neurol Int 2014; 6:5376. [PMID: 24744848 PMCID: PMC3980148 DOI: 10.4081/ni.2014.5376] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Revised: 03/06/2014] [Accepted: 03/07/2014] [Indexed: 11/23/2022] Open
Abstract
Posterior reversible encephalopathy syndrome (PRES) is a clinical-radiologic entity not yet understood, that presents with transient neurologic symptoms and particular radiological findings. Few papers show the differences between pregnant and non-pregnant patients. We review the cases of 38 women diagnosed with PRES, in order to find significant differences between pregnant (18) and non-pregnant (20) patients. We found differences among the age of patients (25.83 years old in pregnant and 29.31 years old in non pregnant; P=0.001); in the mean of highest systolic blood pressure, that was higher in non-pregnant group (185:162 mmHg; P=0.121); and in creatinine levels that was higher in non-pregnant group (3.47:1.04 mg/dL; P=0.001). To our knowledge, just a few papers analyzed whether PRES syndrome presented in the same way in pregnant and non-pregnant patients. The differences and the possible pathophisiology of this syndrome still remain enigmatic.
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Affiliation(s)
- Luiz Carlos Porcello Marrone
- Service of Neurology, Instituto do Cérebro, Hospital São Lucas, Pontifícia Universidade Católica do Rio Grande do Sul , Porto Alegre, Brazil
| | - Giovani Gadonski
- Service of Nephrology, Instituto do Cérebro, Hospital São Lucas, Pontifícia Universidade Católica do Rio Grande do Sul , Porto Alegre, Brazil
| | - Luciano Passamani Diogo
- Service of Neurology, Instituto do Cérebro, Hospital São Lucas, Pontifícia Universidade Católica do Rio Grande do Sul , Porto Alegre, Brazil
| | - João Pedro Farina Brunelli
- Service of Neurology, Instituto do Cérebro, Hospital São Lucas, Pontifícia Universidade Católica do Rio Grande do Sul , Porto Alegre, Brazil
| | - William Alves Martins
- Service of Neurology, Instituto do Cérebro, Hospital São Lucas, Pontifícia Universidade Católica do Rio Grande do Sul , Porto Alegre, Brazil
| | - Gabriela de Oliveira Laguna
- Service of Neurology, Instituto do Cérebro, Hospital São Lucas, Pontifícia Universidade Católica do Rio Grande do Sul , Porto Alegre, Brazil
| | - Laura Fuchs Bahlis
- Service of Neurology, Instituto do Cérebro, Hospital São Lucas, Pontifícia Universidade Católica do Rio Grande do Sul , Porto Alegre, Brazil
| | - João Rubião Hoefel Filho
- Service of Radiology, Instituto do Cérebro, Hospital São Lucas, Pontifícia Universidade Católica do Rio Grande do Sul , Porto Alegre, Brazil
| | - Bartira Ercilia Pinheiro da Costa
- Service of Nephrology, Instituto do Cérebro, Hospital São Lucas, Pontifícia Universidade Católica do Rio Grande do Sul , Porto Alegre, Brazil
| | - Carlos Eduardo Poli-de-Figueiredo
- Service of Nephrology, Instituto do Cérebro, Hospital São Lucas, Pontifícia Universidade Católica do Rio Grande do Sul , Porto Alegre, Brazil
| | - Antônio Carlos Huf Marrone
- Service of Neurology, Instituto do Cérebro, Hospital São Lucas, Pontifícia Universidade Católica do Rio Grande do Sul , Porto Alegre, Brazil
| | - Jaderson Costa da Costa
- Service of Neurology, Instituto do Cérebro, Hospital São Lucas, Pontifícia Universidade Católica do Rio Grande do Sul , Porto Alegre, Brazil
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17
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Porcello Marrone LC, Marrone BF, Neto FK, Costa FC, Thomé GG, Aramburu MB, Schilling LP, Pascoal TA, Gadonski G, Huf Marrone AC, da Costa JC. Posterior reversible encephalopathy syndrome following a scorpion sting. J Neuroimaging 2013; 23:535-6. [PMID: 23551823 DOI: 10.1111/jon.12017] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2012] [Revised: 12/11/2012] [Accepted: 02/23/2013] [Indexed: 01/20/2023] Open
Abstract
Posterior reversible encephalopathy syndrome (PRES) is a clinicoradiologic entity not yet understood, that is present with transient neurologic symptoms and particular radiological findings. The most common imaging pattern in PRES is the presence of edema in the white matter of the posterior portions of both cerebral hemispheres. The cause of PRES is unclear. We report a case of 13-year-old male who was stung by a scorpion and developed a severe headache, visual disturbance, and seizures and had the diagnosis of PRES with a good outcome. Numerous factors can trigger this syndrome, most commonly: acute elevation of blood pressure, abnormal renal function, and immunosuppressive therapy. There are many cases described showing the relationship between PRES and eclampsia, transplantation, neoplasia and chemotherapy treatment, systemic infections, renal disease acute, or chronic. However, this is the first case of PRES following a scorpion sting.
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Affiliation(s)
- Luiz Carlos Porcello Marrone
- Department of Neurology, Hospital São Lucas/Instituto do Cérebro - Pontificia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
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Ogunneye O, Hernandez-Montfort JA, Ogunneye Y, Ogu I, Landry D. Parainfluenza virus infection associated with posterior reversible encephalopathy syndrome: a case report. J Med Case Rep 2012; 6:89. [PMID: 22448715 PMCID: PMC3319422 DOI: 10.1186/1752-1947-6-89] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2011] [Accepted: 03/26/2012] [Indexed: 11/10/2022] Open
Abstract
Introduction Posterior reversible encephalopathy syndrome is a clinical and radiological entity. The most accepted theory of posterior reversible encephalopathy syndrome is a loss of autoregulation in cerebral blood flow with a subsequent increase in vascular permeability and leakage of blood plasma and erythrocytes, producing vasogenic edema. In infection-associated posterior reversible encephalopathy syndrome, a clinical pattern consistent with systemic inflammatory response syndrome develops. Parainfluenza virus has not been reported in the medical literature to be associated with posterior reversible encephalopathy syndrome. Case presentation We report herein the case of a 54-year-old Caucasian woman with posterior reversible encephalopathy syndrome associated with parainfluenza virus infection who presented with generalized headache, blurring of vision, new-onset seizure and flu-like symptoms. Conclusion Infection-associated posterior reversible encephalopathy syndrome as well as hypertension-associated posterior reversible encephalopathy syndrome favor the contribution of endothelial dysfunction to the pathophysiology of this clinicoradiological syndrome. In view of the reversible nature of this clinical entity, it is important that all physicians are well aware of posterior reversible encephalopathy syndrome in patients presenting with headache and seizure activity. A detailed clinical assessment leading to the recognition of precipitant factors in posterior reversible encephalopathy syndrome is paramount.
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Affiliation(s)
- Owolabi Ogunneye
- Department of Medicine, Baystate Medical Center, Tufts University School Of Medicine, 759 Chestnut Street, Springfield, MA 01199, USA.
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