Cyclosporine-related posterior reversible encephalopathy syndrome after cord blood stem cell transplantation

Jennane, Selim; Mahtat, El Mehdi; Konopacki, Johanna; Malfuson, Jean Valère; Doghmi, Kamal; Mikdame, M.; Revel, Thierry de

doi:10.1016/j.hemonc.2013.05.002

Cited by 7 publications

(3 citation statements)

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“…The absence of increased blood pressure in many of the patients supports the cytotoxic theory, as in observed our cases. Immunosuppressive medications, such as CsA, TAC, and steroids, which are the most commonly used drugs for GVHD prophylaxis, can induce PRES in HSCT recipients [ 18 – 20 ]. On MRI, typical findings of cerebral vasogenic oedema as a result of extravasation of plasma proteins and cells into the extracellular space are demonstrated.…”

Section: Discussionmentioning

confidence: 99%

Neuroimaging findings of posterior reversible encephalopathy syndrome (PRES) following haematopoietic stem cell transplantation in paediatric recipients

2021

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Background Haematopoietic stem cell transplantation (HSCT) is used worldwide in various malignant and nonmalignant childhood diseases, including haematologic, genetic, autoimmune and metabolic disorders, and is the only curative treatment for many of these illnesses. The survival rates of many childhood diseases have been increased due to HSCT treatment. However, associated complications are still important for management. Central nervous system (CNS) complications in paediatric HSCT recipients can be associated with high morbidity and significantly contribute to mortality. Posterior reversible encephalopathy syndrome (PRES) is one of the most common CNS complications in patients with neurological symptoms following HSCT. Magnetic resonance imaging (MRI) is the modality of choice and shows typical bilateral vasogenic oedema at the posterior parts of the cerebral hemispheres; however, various atypical imaging manifestations can also occur. In this study, we retrospectively examined CNS complications in our paediatric HSCT recipients with a focus on the typical and atypical neuroimaging manifestations of PRES following HSCT. Methods We retrospectively reviewed the medical records of 300 consecutive paediatric HSCT recipients from January 2014 to November 2018. A total of 130 paediatric HSCT recipients who experienced neurological signs and symptoms and were evaluated with neuroimaging studies following HSCT were enrolled in the study. The timing of CNS complications was defined according to immune status, including the pre-engraftment period (< 30 days after HSCT), the early postengraftment period (30–100 days after HSCT), and the late postengraftment period (> 100 days after HSCT), which were defined as phases 1, 2 and 3, respectively. Results Overall, 130 paediatric HSCT recipients experienced neurological signs and symptoms and therefore underwent neuroimaging examinations. Among these 130 patients, CNS complications were present in 23 patients (17.6%, 23/130), including 13 (56.5%) females and 10 (43.5%) males with a median age of 8.0 years (range, 8 months to 18.0 years). Among these 23 patients, 14 cases of PRES (60.9%), 5 (21.7%) cases of leukoencephalopathy, 3 cases of acute subdural haemorrhage (ASDH) (13%) and 1 (4.3%) case of fungal CNS infection were identified by neuroimaging. On MRI, typical parietooccipital vasogenic oedema was present in 78.5% of the PRES cases (11/14). The following atypical neuroimaging manifestations were observed: isolated involvement of the bilateral frontal lobes in 1 case, isolated cerebellar vermis involvement in 1 case, and isolated basal ganglia involvement in 1 case. Restricted diffusion associated with cytotoxic damage was demonstrated in 2 of 14 cases, one of which also showed subacute cytotoxic injury with ADC pseudonormalization. Conclusion Paediatric HSCT recipients presenting with CNS signs and symptoms should be evaluated by neuroimaging studies for timely diagnosis and early management. PRES is the most common CNS complication and may present with atypical MRI manifestations, which should not dissuade a PRES diagnosis in appropriate clinical settings.

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Section: Discussionmentioning

confidence: 99%

Neuroimaging findings of posterior reversible encephalopathy syndrome (PRES) following haematopoietic stem cell transplantation in paediatric recipients

2021

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“…9 In addition, many medications like steroids and cyclosporine can raise BP and therefore increase the risk of PRES. 10,11 Patients on dialysis can also develop PRES if they become hypertensive. 12,13 Seizures are a common and frequently encountered symptom of PRES, among a wide range of other neurological symptoms.…”

Section: Discussionmentioning

confidence: 99%

Posterior Reversible Encephalopathy Syndrome in Two Omani Children with Underlying Renal Diseases

El-Naggari¹,

Al-Nabhani²,

Elnour³

et al. 2015

Sultan Qaboos Univ Med J

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abstract:Posterior reversible encephalopathy syndrome (PRES) is a neurological condition with a combination of clinical and radiological features. Clinical symptoms include headaches, confusion, seizures, disturbed vision or an altered level of consciousness. Classic magnetic resonance imaging (MRI) findings indicate subcortical and cortical oedema, affecting mainly the posterior cerebral region. We report two paediatric cases of PRES with underlying renal diseases presenting at the Sultan Qaboos University Hospital in Muscat, Oman, in April 2010 and August 2011. The first case was an 11-year-old girl diagnosed with systemic lupus erythematosus and the second was a six-and-a-half-year-old boy on peritoneal dialysis due to multi-drug-resistant nephrotic syndrome. Both patients were hypertensive and treated with blood pressure control medications. No residual neurological dysfunction was noted in the patients at a one-year follow-up and at discharge, respectively. The role of hypertension in paediatric PRES cases, among other important risk factors, is emphasised. Additionally, MRI is an important diagnostic and prognostic tool. Prompt diagnosis and aggressive management is fundamental to preventing permanent neurological damage.

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“…Cyclosporin, ein Interleukin 2-Inhibitor [68], kann ebenfalls ein RPLS auslösen [10,12,16,70,[80][81][82][83][84][85][86][87][88][89][90]. In der Literatur wird über mehr als 100 Cyclosporin-induzierte Fälle berichtet [70].…”

Section: Cyclosporinunclassified

Neurologische Komplikationen antirheumatischer Pharmakotherapeutika

Reimers¹,

Dukiewicz

2016

Akt Rheumatol

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Zusammenfassung Hintergrund: Rheumatische Erkrankungen und deren Pharmakotherapie k?nnen zu ?hnlichen oder identischen Erkrankungen des zentralen und peripheren Nervensystems und der Skelettmuskulatur f?hren. Die Unterscheidung der beiden Ursachen ist von entscheidender therapeutischer Bedeutung, da im Falle einer Komplikation der Grundkrankheit eventuell eine Therapieeskalation und bei unerw?nschter Medikamentennebenwirkung deren Absetzen und h?ufig eine symptomatische medikament?se Therapie erforderlich sind. Methode: Die wichtigsten neurologischen Komplikationen der Pharmakotherapie in der Rheumatologie werden anhand einer Literaturrecherche dargestellt. Ergebnisse: Die gravierendsten neurologischen Komplikationen sind die meist t?dlich verlaufende progressive multifokale Leukoenzephalopathie (Azathioprin, Methotrexat, Cyclosporin, Mycophenolat, Lefunomid, Tumor-Nekrose-Faktor-?-(TNF)-Antagonisten, Rituximab), die posteriore reversible Enzephalopathie (Glukokortikoide, nichtsteroidale Antirheumatika, Azathioprin, Methotrexat, Cyclosporin, Cyclophosphamid, TNF-Antagonisten, Rituximab), andere Enzephalopathien (Sulfasalazin, Cyclosporin), Optikusneuropathien (Cyclosporin, Methotrexat, TNF-Antagonisten), Neuropathien (Dapson, (Hydroxy-)Chloroquin, Cyclosporin, Cyclophosphamid, Leflunomid, TNF-Antagonisten) und Myopathien bzw. Myositiden (Glukokortikoide, (Hydroxy-)Chloroquin. TNF-Antagonisten). Mit Ausnahme der Neuropathien sind diese Komplikationen sehr selten. Weitere gelegentliche ernste Behandlungskomplikationen sind bspw. epileptische Anf?lle, motorische und sensible St?rungen. Leichtere Komplikationen wie Kopfschmerzen oder Tremor treten h?ufiger auf. Schlussfolgerung: Bei der Pharmakotherapie k?nnen neu auftretende neurologische Symptome Hinweise auf eine u. U. gravierende Arzneimittelnebenwirkung sein. Sie bed?rfen in der Regel rascher weiterer Kl?rung.

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Cyclosporine-related posterior reversible encephalopathy syndrome after cord blood stem cell transplantation

Cited by 7 publications

References 1 publication

Neuroimaging findings of posterior reversible encephalopathy syndrome (PRES) following haematopoietic stem cell transplantation in paediatric recipients

Neuroimaging findings of posterior reversible encephalopathy syndrome (PRES) following haematopoietic stem cell transplantation in paediatric recipients

Posterior Reversible Encephalopathy Syndrome in Two Omani Children with Underlying Renal Diseases

Neurologische Komplikationen antirheumatischer Pharmakotherapeutika

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