Reversible Posterior Leukoencephalopathy Syndrome Due to Carboplatin and Paclitaxel Therapy

Abstract

Background: Reversible posterior leukoencephalopathy syndrome (RPLS) is a clinicoradiologic syndrome characterized by headache, decreased alertness, seizures, visual abnormalities, and white matter changes indicative of cerebral edema. Although the pathogenesis remains poorly understood, several etiological causes have been described. RPLS is a common complication of chemotherapeutics because of its toxic effect on the central nervous system. This syndrome is frequently associated with seizures but rarely seen with status epilepticus and periodic lateralized epileptiform discharges (PLEDs). Case Report:We present a case with metastatic lung cancer that developed RPLS after carboplatin and paclitaxel therapy. Our case was admitted to the hospital with status epilepticus and her electroencephalography showed PLEDs. Conclusion: It is important to closely monitor blood pressure and electrolyte levels in patients who take chemotherapeutic agents, especially when there is no previous history of hypertension. It should be kept in mind that RPLS is a causative factor of status epilepticus and PLEDs.

Reversible posterior leukoencephalopathy syndrome following carboplatin and paclitaxel in cervical cancer: Case report

“…Through our literature review, we identified 19 cases of patients experiencing PRES following the administration of chemotherapy drugs with or without targeted therapies, as detailed in Table 1 . 1 – 4 , 6 – 15 …”

Posterior reversible encephalopathy syndrome, a clinically diverse and challenging disorder

“…Hypertension, (pre)eclampsia, hypercalcemia, renal diseases, inflammatory, and autoimmune disorders are the most common underlying conditions . PRES can also manifest after exposure to a number of therapeutic agents, particularly immunosuppressants and cytotoxic agents . Patient‐2 developed PRES following paclitaxel‐carboplatin combination therapy.…”

“…Patient‐2 developed PRES following paclitaxel‐carboplatin combination therapy. The toxicity of platinum analogues has been reported primarily in association with cisplatin, very rarely with carboplatin …”

Neurologic Complications in Patients with Cancer

“…130 Workup of PRES should include brain MRI; the most common finding is symmetrical T2 hyperintensities in the parietal-occipital white matter (►Table 6). 131 Cancer treatments that have (rarely) been linked to PRES include VEG-F inhibitors (bevacizumab), 130,132 taxanes (paclitaxel), 133,134 platinum derivatives (carboplatin, oxaliplatin), 135 Vinca alkaloids (vincristine), 130,136 and methotrexate. 137 Calcineurin inhibitors (tacrolimus, cyclosporine) used for immune-suppression after bone marrow transplant (BMT) have clearly been associated with PRES.…”