Posterior reversible encephalopathy syndrome: Two cases in young adults with acute lymphoblastic leukemia

Reutenauer, S.; Albucher, Jean François; Pariente, Jérémie; Dumas, H.; Milioto, Olivier; Attal, M; Récher, Christian; Huguet, Françoise

doi:10.1016/j.leukres.2008.09.003

Cited by 3 publications

(2 citation statements)

References 14 publications

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“…Although PRES has increasingly been reported in childhood leukemia patients [3], the development of PRES in adult leukemia patients is very rare. To our knowledge, only 3 adult cases during remission induction chemotherapy have been reported to date [4,5]. However, we found that at least three adult cases of PRES, including the present case, in which PRES appeared after using of L-asparaginase in the treatment of ALL, were recorded in Pharmaceutical and Medical Devices Agency (PMDA, Japan) (http://www.info.pmda.go.jp/fsearchnew/ jsp/menu_fukusayou_base.jsp) between 2005 and 2010.…”

Section: Discussionmentioning

confidence: 99%

Posterior reversible encephalopathy syndrome in an adult patient with acute lymphoblastic leukemia after remission induction chemotherapy

et al. 2011

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Posterior reversible encephalopathy syndrome (PRES) has been reported in childhood leukemia patients increasingly frequently. However, the development of PRES in adult leukemia patients during chemotherapy is very rare. We present a case of PRES in an adult patient with acute lymphoblastic leukemia (ALL) after remission induction chemotherapy. A 28-year-old woman with ALL was administered remission induction chemotherapy consisting of cyclophosphamide, daunorubicin, vincristine, prednisone, and L-asparaginase. After initiation of chemotherapy, the patient developed paralytic ileus and hypertension, and on day 30, she suddenly developed generalized convulsions, loss of visual acuity, and muscle weakness in the legs. Magnetic resonance imaging findings and her signs and symptoms were typical of PRES. The symptoms gradually improved following treatment with an anticonvulsant and an antihypertensive agent, and the patient underwent allogeneic bone marrow transplantation. She has completely recovered from PRES and has been asymptomatic without leukemia relapse. During remission induction chemotherapy for ALL, PRES may be caused by multiple drugs, such as L-asparaginase, vincristine, and corticosteroids, with different mechanisms of action. PRES should be recognized as an important complication, which will occur more frequently with the increased intensity of chemotherapy for adult ALL patients.

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Section: Discussionmentioning

confidence: 99%

Posterior reversible encephalopathy syndrome in an adult patient with acute lymphoblastic leukemia after remission induction chemotherapy

et al. 2011

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“…Long term sequelae occurred with irreversible MRI abnormalities in four children, epilepsy in three, and continued abnormal EEG without further seizures in one. Intensive chemotherapy was also identified as a risk factor in two young patients with ALL who developed PRES following acute renal failure, hypertension and seizures during GRALL-2005 induction chemotherapy [10]. A 9-year retrospective analysis of central nervous system (CNS) complications in patients with ALL in a single Italian pediatric institution found PRES being the most frequent neurological complication following treatment with the AIEOP-BFM-ALL-2000 protocol [11].…”

Section: Discussionmentioning

confidence: 99%

Posterior reversible encephalopathy syndrome as the initial presentation of acute lymphoblastic leukaemia

Fadilah

2011

J Hemat Malig

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Posterior reversible encephalopathy syndrome (PRES) is a recognized complication of chemotherapy. However, the development of PRES at presentation of acute lymphoblastic leukemia (ALL) is rare. Here we discuss the uncommon presenting feature of PRES in ALL, and its progression with chemotherapy.A 13-year-old Malay male presented with a one-week history of blurred vision and headache associated with hypertension, hyperkalemia and acute renal failure. CT brain imaging showed symmetrical and bilateral white matter hypodensities at the parietal regions. Brain MRI on T2 and FLAIR images showed patchy areas of high signal intensity at cortical and subcortical region of both parietal and occipital lobes, consistent with PRES. He developed bicytopenia and bone marrow biopsy confirmed pre-B acute lymphoblastic leukemia. He received Phase 1 induction chemotherapy according to the modified UKALL XII protocol but in view of PRES, L-asparaginase and intrathecal methotrexate were delayed until after Day 17 of chemotherapy. No neurological symptoms were observed after chemotherapy. However, during Phase 2 induction chemotherapy with high dose cytarabine and intrathecal methotrexate, he developed accelerated hypertension and status epilepticus requiring mechanical ventilation. Cerebrospinal fluid analysis did not show infection or leukemic infiltration. A repeat brain MRI showed worsening features of the pre-existing PRES, followed by partial resolution on Day 37 of chemotherapy. Subsequent cytotoxic chemotherapies were uneventful except for radiological deterioration of PRES with partial resolution upon hematological recovery.It is important to consider the diagnosis of PRES in a young patient presenting with acute onset of headache and visual disturbances even before the initiation of cytotoxic chemotherapy. In view of the pre-existing PRES, there are risks of further neurological damage and fatal neurological squeal by introducing chemotherapy to treat the leukemia. Therefore it is vital to recognize and treat PRES promptly as early intervention may prevent or reverse the development of encephalopathy.

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Predisposing Factors of Posterior Reversible Encephalopathy Syndrome in Acute Childhood Leukemia

Kim

Lee

et al. 2012

Pediatric Neurology

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Posterior reversible encephalopathy syndrome: Two cases in young adults with acute lymphoblastic leukemia

Cited by 3 publications

References 14 publications

Posterior reversible encephalopathy syndrome in an adult patient with acute lymphoblastic leukemia after remission induction chemotherapy

Posterior reversible encephalopathy syndrome in an adult patient with acute lymphoblastic leukemia after remission induction chemotherapy

Posterior reversible encephalopathy syndrome as the initial presentation of acute lymphoblastic leukaemia

Predisposing Factors of Posterior Reversible Encephalopathy Syndrome in Acute Childhood Leukemia

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