PRES in the course of hemato-oncological treatment in children

Abstract

Introduction Posterior reversible leukoencephalopathy syndrome (PRES) is a clinical syndrome of varying aetiologies, characterised by acute neurological symptoms of brain dysfunction with MRI abnormalities in posterior cerebral white and grey matter. In most cases, symptoms resolve without neurological consequences. Aim The aim of this paper is the analysis of predisposing factors, clinical outcomes and radiological features of PRES in eight children with hemato-oncological disease. Material and methods We analysed the medical records of eight hemato-oncological patients aged from 3.0 to 16.1 years. The mean of age at primary diagnosis was 8.5 years. Results All patients had both clinical and radiological PRES features. Seven out of eight underwent intensive chemotherapy regimens. Time elapsed from start of treatment to the occurrence of PRES ranged from 6 to 556 days. In one case, PRES occurred before chemotherapy and was the first symptom of cancer. Most (six of eight) patients had history of hypertension (> 95pc) and some (two of eight) occurred electrolyte imbalance-mainly hypomagnesaemia. Patients presented headache (seven of eight), disturbances of consciousness (six of eight), seizures (six of eight), visual changes (four of eight) and vomiting (three of eight). MRI demonstrated abnormalities in seven children: typical cerebral oedema in the white matter of the occipital to the parietal lobes. Most patient lesions in the MRI shrunk after 4 weeks, and clinical symptoms of PRES disappeared completely within a few hours to few days. Conclusion PRES may complicate oncological treatment in children. Hypertension is the most important risk factor of PRES. PRES should be included in differential diagnosis in all patients with acute neurological symptoms.

Analysis of Risk Factors Associated With Poor Outcome in Posterior Reversible Encephalopathy Syndrome After Treatment in Children: Systematic Review and Meta-Analysis

“…Despite several recent studies in which the impact of various risk factors on PRES were investigated, the consensus and position statement on these factors on the prognosis of PRES in childhood cancer have still been based on expert opinion and not empirical evidence (2,8,16,(18)(19)(20)(21)(22)(23)(24)(25)(26). Therefore, we believe that our studies are warranted by a more focused review of the literature.…”

Prognostic factors and seizure outcome in posterior reversible encephalopathy syndrome (PRES) in children with hematological malignancies and bone marrow failure: A retrospective monocentric study

“…Hypertension is considered to be another key risk factor of PRES. Severe hypertension leads to failed autoregulation and subsequent hyperperfusion, again with the development of vasogenic edema [21]. Hypertension is often seen in children with PRES (100% according to Morris [12]; 68% according to Kim [6].…”

Posterior Reversible Encephalopathy Syndrome During Acute Lymphoblastic Leukemia Treatment

“…The other hypothesis is the direct cytotoxic effects of the antineoplastic and immunosuppressive drugs, which are methotrexate, vincristine, cyclophosphamide, cyclosporin, tacrolimus, and sirolimus (14) . These agents cause a direct cytotoxic effect on the vascular endothelium and affect the endothelial system (5,6,18) . Eventually, both mechanisms disrupt the blood-brain barrier, and increase the leakage of the plasma and the red blood cells into the cerebrovascular space to the intercellular space and cause vasogenic edema (17,19) .…”

“…The main pathophysiological underlying cause is still unknown, but the dysfunction of the endothelium and blood-brain barrier is the dominant entity (2) . There are many etiological factors for PRES, these include hypertensive encephalopathy, malignancy, stem cell and solid organ transplantations, immunosuppressive and cytotoxic drugs, autoimmune diseases and collagen vascular diseases (2)(3)(4)(5) . For pediatric patients, the most common causes of PRES are acute leukemia, glomerulonephritis, Henoch Schoenlein purpura, and hemolytic uremic syndrome.…”