Posterior reversible encephalopathy syndrome after intrathecal methotrexate infusion: a case report and literature update

Pavlidou, Efterpi; Pavlou, Evangelos; Anastasiou, Athanasia; Pana, Zoi Dorothea; Tsotoulidou, Vasiliki; Kinali, Maria; Hatzipantelis, Emmanuel

doi:10.21037/qims.2016.10.07

Cited by 20 publications

(12 citation statements)

References 37 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In the NOPHO ALL2008 protocol, methotrexate, prednisolone, vincristine, doxorubicin, and asparaginase were given during induction. Methotrexate is known to cause neurotoxicity, commonly leukoencephalopathy and stroke‐like syndrome (SLS), but has also been associated with PRES . Vincristine has mostly been linked to peripheral neuropathy, but emerging data also indicate a possible causal relationship to PRES .…”

Section: Discussionmentioning

confidence: 99%

“…Methotrexate is known to cause neurotoxicity, commonly leukoencephalopathy and stroke-like syndrome (SLS), but has also been associated with PRES. [27][28][29] Vincristine has mostly been linked to peripheral neuropathy, but emerging data also indicate a possible causal relationship to PRES. 9,28,30,31 Prednisolone increases the risk for PRES, probably indirectly due to an increase in blood pressure.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Posterior reversible encephalopathy syndrome in children with acute lymphoblastic leukemia: Clinical characteristics, risk factors, course, and outcome of disease

Anastasopoulou

Eriksson

Heyman

et al. 2018

Pediatric Blood & Cancer

View full text Add to dashboard Cite

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.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Posterior reversible encephalopathy syndrome in children with acute lymphoblastic leukemia: Clinical characteristics, risk factors, course, and outcome of disease

Anastasopoulou

Eriksson

Heyman

et al. 2018

Pediatric Blood & Cancer

View full text Add to dashboard Cite

show abstract

“…As our understanding of this disease has gradually improved, its etiology, clinical and imaging spectrum were more fully and accurately described. The clinical symptoms of PRES typically include (6)(7)(8). When potential triggers are eliminated or blood pressure is controlled, the clinical manifestations and imaging findings of PRES are often reversible (9).…”

Section: Introductionmentioning

confidence: 99%

Risk factors for poor outcome in posterior reversible encephalopathy syndrome: systematic review and meta-analysis

Chen

Zhang

Lerner

et al. 2018

Quant. Imaging Med. Surg.

View full text Add to dashboard Cite

show abstract

“…We think our patient may have RCVS and PRES at the same time, which were triggered by HD‐MTX, but it was difficult to figure out whether PRES was secondary to the RCVS or triggered by HD‐MTX. The previous studies have reported some cases of PRES after intrathecal methotrexate infusion; however, no case reported the existence of RCVS in these patients. Further studies are need to find the mechanism of PRES associated with MTX and the relationship between RCVS and PRES.…”

Section: Discussionmentioning

confidence: 85%

A Case of Reversible Cerebral Vasoconstriction Syndrome Triggered by High‐Dose Methotrexate in a Boy With Lymphoma

et al. 2019

View full text Add to dashboard Cite

Background Reversible cerebral vasoconstriction syndrome (RCVS) is characterized by thunderclap headaches and transient segmental cerebral arterial vasoconstriction. Many drugs have been identified as triggers of RCVS. However, RCVS induced by methotrexate (MTX), an antimetabolite agent, has never been reported. Case We report the first case of a 17‐year‐old Chinese student with a thunderclap headache after administration of high‐dose methotrexate during the treatment of extranodal natural killer/T‐cell lymphoma. Brain magnetic resonance angiography showed segmental constriction of the right anterior cerebral artery A1 segment, combined with nonaneurysmal cortical subarachnoid hemorrhage and vasogenic brain edema in brain magnetic resonance imaging. Cerebral images became normal 6 weeks later. Discussion MTX is associated with a variety of neurological toxicities, including aseptic meningitis, transverse myelopathy, acute and subacute encephalopathy, and leukoencephalopathy. However, this is the first report that MTX can trigger RCVS, although it is not a proof for causality. RCVS should be a differential diagnosis for a headache after MTX administration.

show abstract

Posterior reversible encephalopathy syndrome after intrathecal methotrexate infusion: a case report and literature update

Cited by 20 publications

References 37 publications

Posterior reversible encephalopathy syndrome in children with acute lymphoblastic leukemia: Clinical characteristics, risk factors, course, and outcome of disease

Posterior reversible encephalopathy syndrome in children with acute lymphoblastic leukemia: Clinical characteristics, risk factors, course, and outcome of disease

Risk factors for poor outcome in posterior reversible encephalopathy syndrome: systematic review and meta-analysis

A Case of Reversible Cerebral Vasoconstriction Syndrome Triggered by High‐Dose Methotrexate in a Boy With Lymphoma

Contact Info

Product

Resources

About