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Buenaventura DC, Vargas-Sierra H, Aristizabal-Henao N, Torres-Grajales JL, Aguilar-Londono C, Gutierrez-Restrepo J. Posterior Reversible Encephalopathy Syndrome as an Adverse Effect of Lenvatinib in a Patient with Papillary Thyroid Carcinoma: A Case Report. Int J Endocrinol Metab 2023; 21:e136900. [PMID: 38028246 PMCID: PMC10676670 DOI: 10.5812/ijem-136900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 07/05/2023] [Accepted: 07/08/2023] [Indexed: 12/01/2023] Open
Abstract
Posterior reversible encephalopathy syndrome (PRES) is an uncommon transient neuroradiological phenomenon that develops vasogenic cerebral edema and could be caused by some pharmacological agents, such as molecular-specific target agents. Lenvatinib belongs to the tyrosine kinase inhibitors and was approved in 2015 for progressive locally advanced or metastatic thyroid cancer refractory to radioactive iodine (I-131) treatment. Herein, we present the case of a 65-year-old woman who, while receiving treatment with lenvatinib for radioiodine-refractory metastatic papillary thyroid carcinoma, developed PRES without hypertension at the initial evaluation. Her clinical and radiological findings improved after withdrawing from the mentioned therapy, and later it was possible to re-incorporate lower doses of the medication, as described in the other three case reports found in the worldwide medical literature. The recognition of this entity is essential to timely suspend the drug and avoid greater comorbidity. This is the first paper reporting this kind of adverse event using lenvatinib in a Hispanic population.
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Affiliation(s)
| | - Hernando Vargas-Sierra
- Endocrinology Fellowship Program, Universidad Pontificia Bolivariana, Medellín (ZC 50001), Colombia
| | - Natalia Aristizabal-Henao
- Department of Endocrinology, Universidad Pontificia Bolivariana, Medellín (ZC 50001), Colombia
- Department of Endocrinology, Universidad CES, Medellín (ZC 50001), Colombia
- Department of Endocrinology, Clínica Las Americas AUNA, Medellín (ZC 50001), Colombia
| | - Jose Luis Torres-Grajales
- Department of Endocrinology, Universidad Pontificia Bolivariana, Medellín (ZC 50001), Colombia
- Department of Endocrinology, Universidad CES, Medellín (ZC 50001), Colombia
- Department of Endocrinology, Clínica Las Americas AUNA, Medellín (ZC 50001), Colombia
| | | | - Johnayro Gutierrez-Restrepo
- Department of Endocrinology, Clínica Somer, Medellín (ZC 50001), Colombia
- Department of Endocrinology an Metabolism, Universidad de Antioquia, Medellín (ZC 50001), Colombia
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Tseng YJ, Chen CN, Hong RL, Kung WM, Huang APH. Posterior Reversible Encephalopathy Syndrome after Lenvatinib Therapy in a Patient with Olfactory Neuroblastoma. Brain Sci 2022; 13:brainsci13010033. [PMID: 36672016 PMCID: PMC9856907 DOI: 10.3390/brainsci13010033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 12/15/2022] [Accepted: 12/20/2022] [Indexed: 12/28/2022] Open
Abstract
Posterior reversible encephalopathy syndrome (PRES) is a rare but severe neurological syndrome that may stem from the use of some medications. Although its mechanism is not well-known, hypertension and endothelial dysfunction have been mentioned in previous literature as being related. Lenvatinib serves as a neoplastic agent that inhibits the tyrosine kinase of vascular endothelial growth factor receptors (VEGFR). VEGFR inhibitors result in endothelial dysfunction and consequent hypertension by nitric oxide pathway suppression and endothelin (ET)-1 stimulation. We hypothesized that VEGFR inhibitors would cause PRES. Herein, we report the case of a 40-year-old man with olfactory neuroblastoma who developed PRES while undergoing treatment with lenvatinib, 7 months after initiation. The symptoms included loss of consciousness and seizures. Fortunately, the symptoms and presence of PRES in imaging resolved, 7 days and 1 month, respectively, after cessation of lenvatinib.
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Affiliation(s)
- Yu-Ju Tseng
- Department of Pharmacy, National Taiwan University Hospital, Taipei City 100, Taiwan
| | - Chun-Nan Chen
- Department of Otolaryngology, National Taiwan University Hospital, Taipei City 100, Taiwan
| | - Ruey-Long Hong
- Department of Oncology, National Taiwan University Hospital, Taipei City 100, Taiwan
| | - Woon-Man Kung
- Department of Exercise and Health Promotion, College of Kinesiology and Health, Chinese Culture University, Taipei City 111, Taiwan
- Division of Neurosurgery, Department of Surgery, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City 231, Taiwan
| | - Abel Po-Hao Huang
- Department of Surgery, National Taiwan University Hospital, Taipei City 100, Taiwan
- Correspondence:
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Airò G, Maffezzoli M, Lazzarin A, Bianconcini M, Greco A, Buti S, Leonetti A. Takotsubo syndrome in a patient with metastatic renal cell carcinoma treated with pembrolizumab plus axitinib. Immunotherapy 2022; 14:1297-1305. [DOI: 10.2217/imt-2022-0013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
We report the case of a patient with metastatic renal cell carcinoma who developed Takotsubo syndrome (TTS) 6 days after starting pembrolizumab plus axitinib as first-line treatment. Coronary angiogram was negative for obstructive coronary artery disease and echocardiogram revealed a depressed left ventricular ejection fraction with apical akinesis. Axitinib was discontinued and myocardial contractile function fully recovered 23 days after the initial presentation. The treatment was safely resumed and granted a partial response of disease. A literature review regarding TTS in patients receiving VEGFR tyrosine kinase inhibitors and/or immune checkpoint inhibitors was performed. TTS is reported as a rare adverse event and the possible causal relationship between TTS and antineoplastic therapy is still unclear. Further research is warranted to better understand cardiotoxicity mechanisms and their management.
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Affiliation(s)
- Giulia Airò
- Medical Oncology Unit, University Hospital of Parma, Parma, 43126, Italy
| | - Michele Maffezzoli
- Medical Oncology Unit, University Hospital of Parma, Parma, 43126, Italy
| | | | | | - Alessandro Greco
- Cardiology Unit, University Hospital of Parma, Parma, 43126, Italy
| | - Sebastiano Buti
- Medical Oncology Unit, University Hospital of Parma, Parma, 43126, Italy
- Department of Medicine & Surgery, University of Parma, Parma, 43126, Italy
| | - Alessandro Leonetti
- Medical Oncology Unit, University Hospital of Parma, Parma, 43126, Italy
- Department of Medicine & Surgery, University of Parma, Parma, 43126, Italy
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Angelousi A, Hayes AR, Chatzellis E, Kaltsas GA, Grossman AB. Metastatic medullary thyroid carcinoma: a new way forward. Endocr Relat Cancer 2022; 29:R85-R103. [PMID: 35521769 PMCID: PMC9175549 DOI: 10.1530/erc-21-0368] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Accepted: 04/26/2022] [Indexed: 11/21/2022]
Abstract
Medullary thyroid carcinoma (MTC) is a rare malignancy comprising 1-2% of all thyroid cancers in the United States. Approximately 20% of cases are familial, secondary to a germline RET mutation, while the remaining 80% are sporadic and also harbour a somatic RET mutation in more than half of all cases. Up to 15-20% of patients will present with distant metastatic disease, and retrospective series report a 10-year survival of 10-40% from time of first metastasis. Historically, systemic therapies for metastatic MTC have been limited, and cytotoxic chemotherapy has demonstrated poor objective response rates. However, in the last decade, targeted therapies, particularly multitargeted tyrosine kinase inhibitors (TKIs), have demonstrated prolonged progression-free survival in advanced and progressive MTC. Both cabozantinib and vandetanib have been approved as first-line treatment options in many countries; nevertheless, their use is limited by high toxicity rates and dose reductions are often necessary. New generation TKIs, such as selpercatinib or pralsetinib, that exhibit selective activity against RET, have recently been approved as a second-line treatment option, and they exhibit a more favourable side-effect profile. Peptide receptor radionuclide therapy or immune checkpoint inhibitors may also constitute potential therapeutic options in specific clinical settings. In this review, we aim to present all current therapeutic options available for patients with progressive MTC, as well as new or as yet experimental treatments.
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Affiliation(s)
- Anna Angelousi
- Unit of Endocrinology, First Department of Internal Medicine, Laiko Hospital, National and Kapodistrian University of Athens, Athens, Greece
- Correspondence should be addressed to A Angelousi or A B Grossman: or
| | - Aimee R Hayes
- Neuroendocrine Tumour Unit, ENETS Centre of Excellence, Royal Free Hospital, London, UK
| | - Eleftherios Chatzellis
- Endocrinology Diabetes and Metabolism Department, 251 Hellenic Air Force and VA General Hospital, Athens, Greece
| | - Gregory A Kaltsas
- First Department of Propaedeutic Internal Medicine, Laiko Hospital, National & Kapodistrian University of Athens, Athens, Greece
| | - Ashley B Grossman
- Neuroendocrine Tumour Unit, ENETS Centre of Excellence, Royal Free Hospital, London, UK
- Green Templeton College, University of Oxford, Oxford, UK
- Centre for Endocrinology, Barts and the London School of Medicine, London, UK
- Correspondence should be addressed to A Angelousi or A B Grossman: or
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Hamidi S, Boucher A, Lemieux B, Rondeau G, Lebœuf R, Ste-Marie LG, Le XK, Mircescu H. Lenvatinib Therapy for Advanced Thyroid Cancer: Real-life Data on Safety, Efficacy and Some Rare Side Effects. J Endocr Soc 2022; 6:bvac048. [PMID: 35475024 PMCID: PMC9032633 DOI: 10.1210/jendso/bvac048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Indexed: 11/19/2022] Open
Abstract
Context The SELECT trial led to the approval of lenvatinib for the treatment of advanced radioiodine-refractory differentiated thyroid carcinomas (DTCs) but also revealed an important adverse event (AE) profile which may limit its use in clinical practice. Objective We aim to describe the efficacy and toxicity profiles of lenvatinib in real life. Methods We included all patients who received lenvatinib for an advanced DTC at our institution, enrolling 27 patients. We reviewed retrospectively electronic medical records to assess efficacy and AEs. Results Among the 24 patients with evaluation of tumor response during treatment, overall response rate (ORR) was 37.0% (95% CI, 19.4%-57.6%), and disease control rate was 85.2% (95% CI, 66.3%-95.8%). The median progression-free survival (PFS) was 12 months (95% CI, 7.5-16.5]. The most prevalent AEs were hypertension (77.8%), fatigue (55.6%), and weight loss (51.9%). At least one grade ≥ 3 AE was experienced by 25/27 patients (92.6%), mostly hypertension (59.3%). Lenvatinib was discontinued due to AEs in 13/27 patients (48.1%). Interestingly, 1 patient experienced a grade 4 posterior reversible encephalopathy syndrome, and another developed a Takotsubo cardiomyopathy. Conclusion The safety profile of lenvatinib in our cohort was similar to that reported in the literature, with a predominance of hypertension. Rigorous blood pressure control is therefore essential to avoid discontinuing therapy. We also report 2 severe and rarely described AEs that physicians should watch for. As for efficacy, although less than in the SELECT trial, ORR and PFS were similar to other real-life studies.
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Affiliation(s)
- Sarah Hamidi
- Division of Endocrinology, Department of Medicine, Centre Hospitalier de l’Université de Montréal (CHUM), Montréal, QC, Canada
| | - Andrée Boucher
- Division of Endocrinology, Department of Medicine, Centre Hospitalier de l’Université de Montréal (CHUM), Montréal, QC, Canada
| | - Bernard Lemieux
- Division of Medical Oncology, Department of Medicine, CHUM, Montréal, QC, Canada
| | - Geneviève Rondeau
- Division of Endocrinology, Department of Medicine, Centre Hospitalier de l’Université de Montréal (CHUM), Montréal, QC, Canada
| | - Rebecca Lebœuf
- Division of Endocrinology, Department of Medicine, Centre Hospitalier de l’Université de Montréal (CHUM), Montréal, QC, Canada
| | - Louis-Georges Ste-Marie
- Division of Endocrinology, Department of Medicine, Centre Hospitalier de l’Université de Montréal (CHUM), Montréal, QC, Canada
| | - Xuan Kim Le
- Division of Medical Oncology, Department of Medicine, CHUM, Montréal, QC, Canada
| | - Hortensia Mircescu
- Division of Endocrinology, Department of Medicine, Centre Hospitalier de l’Université de Montréal (CHUM), Montréal, QC, Canada
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Takotsubo Cardiomyopathy as Epiphenomenon of Cardiotoxicity in Patients With Cancer: A Meta-summary of Case Reports. J Cardiovasc Pharmacol 2021; 78:e20-e29. [PMID: 34001727 DOI: 10.1097/fjc.0000000000001026] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 03/06/2021] [Indexed: 12/16/2022]
Abstract
ABSTRACT Many antitumoral drugs have been linked to takotsubo cardiomyopathy, with no clear pathogenetic mechanisms. Data about this condition are lacking in literature. The aim of this meta-summary is to summarize the characteristics of patients with antitumoral drug-induced takotsubo cardiomyopathy, described in case reports available in literature. We searched for published case reports in PubMed, Google Scholar, EMBASE, and Scopus from 2009 about stress cardiomyopathy and antiblastic drugs. We selected 41 case reports. All cases underwent chemotherapy/immunotherapy for different types of cancer. The median age was 58 years, and 61% of them were women. The most common comorbidities were hypertension (12.2%) and dyslipidemia (4.9%), but most of the population had no cardiological clinical history. Takotsubo cardiomyopathy is associated to the 5-fluorouracil (36.5%), capecitabine (9.7%), trastuzumab (9.7%), and immune check point inhibitor (9.7%) treatment. The median time of onset was 2 days (1-150). Cardiogenic shock was the first manifestation in 11 patients (26.8%). Left ventricle ejection fraction recovery was showed in 33 patients (89%) with mean ejection fraction 57.7 ± 7%, after a median of 30-day (4-300) follow-up. Patients with cancer experienced takotsubo cardiomyopathy within few days from the beginning of therapy, and the most of them normalized the heart function in few weeks. Cardiogenic shock showed high prevalence in this setting of patients. Larger studies are needed to better understand the pathological mechanisms of antiblastic drug-induced stress cardiomyopathy, to find risk factors associated and preventive strategies for limit this type of cardiotoxicities.
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Gild ML, Tsang VHM, Clifton-Bligh RJ, Robinson BG. Multikinase inhibitors in thyroid cancer: timing of targeted therapy. Nat Rev Endocrinol 2021; 17:225-234. [PMID: 33603220 DOI: 10.1038/s41574-020-00465-y] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/18/2020] [Indexed: 02/06/2023]
Abstract
In the 9 years since the publication of our 2011 review of targeted treatment of thyroid cancer with multikinase inhibitors, much has changed in the landscape of this heterogeneous disease. New multikinase and selective inhibitor treatments for medullary thyroid cancer, radioiodine-refractory thyroid cancer and anaplastic thyroid cancer have completed trials and improved progression-free survival. Many physicians are concerned by dose-limiting adverse effects of these drugs and are wary to begin treatment in patients who are systemically well but have marked disease burden, which makes the timing of treatment initiation challenging. Published mechanistic data on tyrosine kinase inhibitors (TKIs) have helped guide our understanding of how to dose effectively with these drugs. A major goal in TKI therapy is to optimize inhibition of oncogenic kinase drivers while maintaining patient quality of life. Real-world data have now been published on how TKIs have fared outside the clinical trial environment. In this Review, we provide a summary of published data on the efficacy of TKIs in clinical practice, to provide clinicians with a more realistic view of how their patients will manage and respond to TKI therapy. Furthermore, we review the data on mechanisms of inhibition, outcomes and adverse effects of TKIs and provide an update on targeted treatment of thyroid cancer, focusing on optimizing the timing of treatment initiation.
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Affiliation(s)
- Matti L Gild
- Department of Endocrinology and Diabetes, Royal North Shore Hospital, Sydney, NSW, Australia.
- Cancer Genetics, Kolling Institute of Medical Research, Sydney, NSW, Australia.
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.
| | - Venessa H M Tsang
- Department of Endocrinology and Diabetes, Royal North Shore Hospital, Sydney, NSW, Australia
- Cancer Genetics, Kolling Institute of Medical Research, Sydney, NSW, Australia
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Roderick J Clifton-Bligh
- Department of Endocrinology and Diabetes, Royal North Shore Hospital, Sydney, NSW, Australia
- Cancer Genetics, Kolling Institute of Medical Research, Sydney, NSW, Australia
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Bruce G Robinson
- Department of Endocrinology and Diabetes, Royal North Shore Hospital, Sydney, NSW, Australia
- Cancer Genetics, Kolling Institute of Medical Research, Sydney, NSW, Australia
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
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Perwez T, Wahab A, Ahmed Z, Khan A, Ahmed Z. Posterior Reversible Encephalopathy Syndrome (PRES) and Takotsubo: A Heart and Brain Affair! Cureus 2021; 13:e13452. [PMID: 33767936 PMCID: PMC7984408 DOI: 10.7759/cureus.13452] [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] [Indexed: 11/07/2022] Open
Abstract
Takotsubo cardiomyopathy (TC) is characterized by reversible left ventricle systolic dysfunction usually associated with stressors (physiological, psychological) being triggering factors. The increase in sympathetic activity, along with a subsequent surge of catecholamines, has been hypothesized as a possible etiology of TC. Posterior reversible encephalopathy syndrome (PRES), a relatively rare and recently recognized reversible clinico-radiological syndrome, is thought to share the same pathophysiology as TC. We present a case of an 83-year-old female who presented with seizures and was found to have PRES. Within three days of hospitalization, she developed takotsubo. She endorsed being under significant emotional stress that was thought to be the common culprit for both of her syndromes, i.e., PRES and TC.
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Affiliation(s)
- Talha Perwez
- Internal Medicine, University of Alabama at Birmingham (UAB), Montgomery, USA
| | - Ahsan Wahab
- Internal Medicine Department, Baptist Medical Center South, Montgomery, USA
| | - Zunirah Ahmed
- Gastroenterology, Methodist Health System, Houston, USA
| | - Aqsa Khan
- Medicine, Fatima Jinnah Medical University, Lahore, PAK
| | - Zahoor Ahmed
- Internal Medicine, King Edward Medical University, Mayo Hospital, Lahore, PAK
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Stuetz M, Templin C, Templin-Ghadri JR, Ruschitzka F, Pohl H, Hofer D. Acute heart and brain failure: a case report. EUROPEAN HEART JOURNAL-CASE REPORTS 2021; 4:1-8. [PMID: 33447724 PMCID: PMC7793236 DOI: 10.1093/ehjcr/ytaa352] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Revised: 11/12/2019] [Accepted: 08/30/2020] [Indexed: 11/14/2022]
Abstract
Background Takotsubo syndrome (TTS) is characterized by often reversible but acute heart failure occurring after an emotional or physical trigger event. The 'brain failure' counterpart is posterior reversible encephalopathy syndrome (PRES) characterized by often reversible but acute neurological symptoms. This case report elaborates on a complex clinical scenario with co-existence of coronary artery disease, TTS and PRES and discusses the pathophysiology, differential diagnosis, and management. Case summary An 82-year-old woman presented with acute heart failure and generalized tonic-clonic seizures following an acute exacerbation of her chronic back pain. Brain magnetic resonance imaging demonstrated vasogenic oedema consistent with the diagnosis of PRES. Focal wall motion abnormalities on echocardiography without causal coronary stenoses on angiography were consistent with the diagnosis of TTS. After an interdisciplinary approach to differential diagnosis and treatment, the patient was discharged to geriatric rehabilitation without heart failure or neurological defects 4 weeks later. Discussion TTS and PRES share significant similarities in proposed pathogenesis, epidemiology, management, and clinical outcome. This case report highlights the need for early recognition of this rare association and multidisciplinary approach to diagnosis and treatment as both heart and brain disease may require early intervention up to rapid intensive care support.
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Affiliation(s)
- Magdalena Stuetz
- Department of Cardiology, University Heart Center Zurich, University Hospital Zurich, Raemistrasse 100, 8006 Zurich, Switzerland
| | - Christian Templin
- Department of Cardiology, University Heart Center Zurich, University Hospital Zurich, Raemistrasse 100, 8006 Zurich, Switzerland
| | - Jelena-Rima Templin-Ghadri
- Department of Cardiology, University Heart Center Zurich, University Hospital Zurich, Raemistrasse 100, 8006 Zurich, Switzerland
| | - Frank Ruschitzka
- Department of Cardiology, University Heart Center Zurich, University Hospital Zurich, Raemistrasse 100, 8006 Zurich, Switzerland
| | - Heiko Pohl
- Department of Neurology, University Hospital Zurich, Frauenklinikstrasse 26, 8091 Zurich, Switzerland
| | - Daniel Hofer
- Department of Cardiology, University Heart Center Zurich, University Hospital Zurich, Raemistrasse 100, 8006 Zurich, Switzerland
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Ghali MGZ, Styler MJ. Etiologies, Cerebral Vasomotion, and Endothelial Dysfunction in the Pathophysiology of Posterior Reversible Encephalopathy Syndrome in Pediatric Patients. JOURNAL OF PEDIATRIC NEUROLOGY 2020. [DOI: 10.1055/s-0040-1702934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
AbstractThe posterior reversible encephalopathy syndrome was characterized by Hinchey and colleagues in the 1990s. The condition frequently afflicts patients suffering from hematologic and solid organ malignancy and individuals undergoing transplantation. Cases are more frequently described in the adult population compared with children. In the pediatric population, malignancy, transplantation, renal disease, and hypertension represent the most common etiologies. Theories on pathogenesis have centered upon cerebrovascular dysautoregulation with increases in blood–brain barrier permeability. This generates vasogenic edema of the cerebral parenchyma and consequent neurologic deficits. The parietal and occipital lobes are affected with greatest prevalence, though frontal and temporal lobe involvement is frequent, and that of the contents of the infratentorial posterior cranial fossa are occasionally described. The clinical presentation involves a characteristic constellation of neurologic signs and symptoms, most typically inclusive of headache, visual-field disturbances, abnormalities of visual acuity, and seizures. Supportive care, withdrawal of the offending agent, antihypertensive therapy, and prophylactic anticonvulsants affect convalescence in majority of cases. The principal challenge lies in identifying the responsible agent precipitating the condition in patients with malignancy and those having undergone transplantation and thus deciding which medication among a multidrug treatment regimen to withhold, the duration of drug cessation required to effect clinical resolution, and the safety of resuming treatment with the compound. We accordingly reviewed and evaluated the literature discussing the posterior reversible encephalopathy syndrome in children.
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Affiliation(s)
- Michael G. Z. Ghali
- Department of Neurological Surgery, Houston Methodist Hospital, Houston, Texas, United States
| | - Michael J. Styler
- Department of Hematology and Oncology, Hahnemann University Hospital, Philadelphia, Pennsylvania, United States
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