Ocular Dysfunctions Presenting in Tacrolimus‐Induced Posterior Reversible Encephalopathy Syndrome: A Case Presentation

Brown, Cora H.; Feng, Alexander; Cruz, Ernesto

doi:10.1016/j.pmrj.2017.07.079

Cited by 4 publications

(3 citation statements)

References 10 publications

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“…In rare occasions, myelopathic symptoms and signs from spinal cord involvement have been demonstrated (40). Other uncommon presentations include abulia, agitation, delusions, ophisthotonus, optic ataxia, ocular apraxia, and simultagnosia (41)(42)(43)(44).…”

Section: Uncommon Clinical Manifestationsmentioning

confidence: 99%

Posterior Reversible Encephalopathy Syndrome: Clinical Features and Outcome

2020

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Background: Posterior reversible encephalopathy syndrome (PRES) is an acute neurotoxic syndrome that is characterized by a spectrum neurological and radiological feature from various risk factors. Common neurological symptoms includes headache, impairment in level of consciousness, seizures, visual disturbances, and focal neurological deficits. Common triggering factors include blood pressure fluctuations, renal failure, eclampsia, exposure to immunosuppressive or cytotoxic agents and autoimmune disorders. The classic radiographic findings include bilateral subcortical vasogenic edema predominantly affecting the parieto-occipital regions but atypical features include involvement of other regions, cortical involvement, restricted diffusion, hemorrhage, contrast enhancement. This review is aimed to summarize the updated knowledge on the typical and atypical clinical and imaging features, prognostic markers and identify gaps in literature for future research. Methods: Systematic literature review using PUBMED search from 1990 to 2019 was performed using terms PRES was performed. Results: While clinical and radiographic reversibility is common, long-standing morbidity and mortality can occur in severe forms. In patients with malignant forms of PRES, aggressive care has markedly reduced mortality and improved functional outcomes. Although seizures were common, epilepsy is rare. Various factors that have been associated with poor outcome include altered sensorium, hypertensive etiology, hyperglycemia, longer time to control the causative factor, elevated C reactive protein, coagulopathy, extensive cerebral edema, and hemorrhage on imaging. Conclusion: Large prospective studies that accurately predict factors that are associated with poor outcomes, determine the pathophysiology, and targeted therapy are required.

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Section: Uncommon Clinical Manifestationsmentioning

confidence: 99%

Posterior Reversible Encephalopathy Syndrome: Clinical Features and Outcome

2020

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“…The latter refers to the release of potent vasoconstrictors that cause vasospasm and ischaemia. The latter hypothesis is usually associated with worse outcomes and with medications such as cyclosporine and tacrolimus 5 13 26…”

Section: Discussionmentioning

confidence: 99%

“…Multiple conditions are associated with this syndrome including the use of immunosuppressive drugs (mainly cyclosporine and tacrolimus), autoimmune diseases (such as lupus erythematosus and antiphospholipid antibody syndrome), hepatorenal syndrome, organ transplantation, dialysis, cocaine use and porphyria 1 6 8–13. Many chemotherapeutic drugs, such as cisplatin, oxaliplatin, carboplatin, gemcitabine, cytarabine, methotrexate, vincristine and fluorouracil, have also been implicated 14 15.…”

Section: Introductionmentioning

confidence: 99%

Posterior reversible encephalopathy syndrome associated with the use of chemotherapeutic agents: a rare complication after treatment with vinorelbine

et al. 2020

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The posterior reversible encephalopathy syndrome (PRES) is a clinicoradiological syndrome characterised by a combination of headache, encephalopathy, seizures and visual disturbances, associated with high-intensity abnormalities on T2-weighted images affecting subcortical white and grey matter of the occipital and parietal lobes. Among other causes, PRES has been associated with the use of several medications including chemotherapeutic agents. Here we report a case of a 65-year-old patient with squamous cell carcinoma of the lung treated with cisplatin/vinorelbine. Following the second administration of vinorelbine, she was admitted to the hospital for a generalised seizure. Blood pressure was just slightly elevated and, except for drowsiness, she had a near-normal neurological examination. MRI corroborated the diagnosis. Vinorelbine-induced PRES has been reported only once in the literature, also in association with cisplatin. Our case underlines the role of vinorelbine and suggests that its association with cisplatin in this setting may enhance the risk of PRES.

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