Posterior reversible encephalopathy syndrome in cancer patients: a single institution retrospective study

Abstract

Posterior reversible encephalopathy syndrome (PRES) is a clinico-radiologic entity. Its management and outcome in the oncology population is limited because it is still difficult to identify despite an increasingly recognized occurrence. This is the largest retrospective study of PRES in cancer patients reported from a single institution. We explore the clinical manifestations and radiologic features to comprehensively assess PRES in order to prevent permanent neurologic deficits and mortality. We retrospectively identified 69 patients with cancer who developed PRES at MDACC between 01/2006 to 06/2012. Clinical and radiographic data were abstracted from their records and reviewed for our analysis. Mean age at PRES onset was 52 ± 17.8 years. Fifty-two (75 %; p < 0.001) patients were women. Most common diagnoses were leukemia (30 %) and lymphoma (12 %). Forty-eight (70 %) patients were treated with chemotherapy, 21 (30 %) bone marrow transplant and 14 (20 %) tacrolimus. Most common clinical presentation was seizures (67 %). PRES was associated with hypertension in 62 (90 %) patients. On brain MRI, 33 (44 %) patients had some evidence of hemorrhage, 22 (73 %) of these were thrombocytopenic. Thirty-five (51 %) patients fully recovered and 19 (28 %) had permanent neurological deficits. Morbidity and mortality were associated with continuation with offending agent, thrombocytopenia, variations in mean arterial pressure ≥20 mmHg, electrographic seizures at onset, atypical MRI pattern and delay in diagnostic imaging (7.4 ± 4.8 days vs. 1.9 ± 1.8 days; p = 0.031) as half of them did not receive a prompt intervention. Special attention should be given to patients who present with high-risk factors in order to prevent development of PRES or decrease patient morbidity and mortality. Management of PRES should be guided by the radiographic findings. Overall, early recognition, discontinuation of the offending agents, correction of thrombocytopenia and blood pressure control are still the main strategies to manage PRES.

A survey on hematology‐oncology pediatric AIEOP centres: The challenge of posterior reversible encephalopathy syndrome

“…We found that the majority of cases of PRES were recorded after a cycle of chemotherapy, as recently observed in cancer adult patients. 14 This must be stressed, because it configures this syndrome as a relatively common complication in the clinical practice of hematologyoncology pediatrician, not exclusively related to HSCT.…”

Controversy of posterior reversible encephalopathy syndrome: what have we learnt in the last 20 years?

“…In most situations, patients with unfavourable outcomes are more frequently seen in state of neurotoxicity such as chemotherapy, sepsis and frequently have serious underlying medical conditions, such as neoplasm, autoimmune disease or infection/sepsis/shock. However, elimination of these neurotoxic states may be difficult in such challenging clinical settings 53. However, a delay in the elimination of the causative factor may also represent an important predictor of poor outcome, which might further explain the seemingly worse prognosis of these patients 54.…”

Cerebral HSV-1 Vasculitis as a Fatal Complication of Immunosuppression in Non-Hodgkin´s Lymphoma: A Case Report and Review of the Literature

“…However, in addition to secondary CNS manifestation and HSV-1 related vasculitis, there are further causes of neurological deterioration in SMZL. Posterior leukoencephalopathy syndrome and vasoconstriction syndrome are clinical mimics of encephalitis, that show vascular alterations and has been reported in the context of lymphoma and with the oncological therapies used in our patient [42,43]. Ibrutinib, a Bruton's tyrosine kinase inhibitor, has been increasingly widely used in relapsed and refractory SMZL.…”