P0034 / #1995: POSTERIOR REVERSIBLE ENCEPHALOPATHY SYNDROME: OCCURRENCE AND CLINICAL CHARACTERISTICS IN CHILDREN WITH CANCER

Abstract Background Posterior reversible encephalopathy syndrome (PRES) is usually a benign, yet underdiagnosed clinical condition associated with subacute to acute neurological manifestations primarily affecting white matter. PRES is reversible when recognized promptly and treated early by removal of the insulting factor; however, can lead to irreversible and life-threatening complications such as cerebral hemorrhage, cerebellar herniation, and refractory status epilepticus. Methods We utilized the National Inpatient Sample database provided by the Healthcare Cost and Utilization Project (HCUP-NIS) 2017 to investigate the demographic variables (age, sex, and race) for patients with PRES, concomitant comorbidities and conditions, inpatient complications, inpatient mortality, length of stay (LOS), and disposition. Results A total of 635 admissions for patients aged 18 years or older with PRES were identified. The mean age was 57.2 ± 0.6 years old with most encounters for female patients (71.7%, n = 455) and white as the most prevalent race. Half the patients in our study presented with seizures (50.1%, n = 318), sixty-three patients (9.9%) presented with vision loss, and sixty-four patients (10.1%) had speech difficulty. In addition, 45.5% of patients had hypertensive crisis (n = 289). 2.2% of hospitalizations had death as the outcome (n = 14). The mean LOS was 8.2 (±0.3) days, and the mean total charges were $92,503 (±$5758). Inpatient mortality differed between males and females (1.7% vs. 2.4%) and by race (3.6% in black vs. 1.8% in white) but was ultimately determined to be not statistically significant. Most patients who present with vision disturbance have a high risk of intracranial hemorrhage. Furthermore, end-stage renal disease, atrial fibrillation, and malignancy seemed to be linked with a very high risk of mortality. Conclusion PRES, formerly known as reversible posterior leukoencephalopathy, is a neurological disorder with variable presenting symptoms. Although it is generally a reversible condition, some patients suffer significant morbidity and even mortality. To the best of our knowledge, this is the largest retrospective cohort of PRES admissions that raises clinician awareness of clinical characteristics and outcomes of this syndrome.

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Posterior Reversible Encephalopathy Syndrome: Occurrence and Clinical Characteristics in Children with Cancer

Proceedings of IMPRS ◽

10.18060/24770 ◽

2020 ◽

Vol 3 ◽

Author(s):

Katherine Sommers ◽

Jodi Skiles ◽

Brian Leland ◽

Courtney Rowan

Keyword(s):

Risk Factors ◽

Posterior Reversible Encephalopathy Syndrome ◽

Hematopoietic Cell Transplantation ◽

Chemotherapeutic Agents ◽

National Institutes Of Health ◽

Categorical Variables ◽

High Morbidity ◽

Children With Cancer ◽

Posterior Reversible Encephalopathy ◽

Reversible Encephalopathy

This project was funded, in part, with support from the Indiana Clinical and Translational Sciences Institute funded, in part by UL1TR002529 from the National Institutes of Health. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Background: The diagnosis and outcomes of posterior reversible encephalopathy syndrome (PRES) in children with cancer are not well understood. We aim to determine the incidence of PRES in pediatric oncology patients, describe the associated morbidity and mortality, and to better understand risk factors in this patient population. Project Methods: We screened 473 children with a hematologic malignancy or post-allogeneic hematopoietic cell transplantation (HCT) between June 2015 and June 2020 for PRES to determine incidence and if age or diagnosis is associated with PRES. To evaluate if comorbidities or chemotherapeutic agents are associated with PRES, we conducted a case-control study. Children with PRES were matched with two controls based on age and diagnosis to identify additional risk factors for PRES development. Incidence was calculated over the 5-year period. Mann Whitney U and Chi-Squared or Fisher Exact Tests were performed using SPSS v26 to compare continuous and categorical variables respectively. Results: Fourteen (3.0%) patients developed PRES, resulting in an incidence of 5.9/1000 people/year. Median age was not different between those that developed PRES [14 years (IQR: 11, 17.25)] and those that did not [9.6 years (IQR: 3.8, 15.4)], (p=0.421). Allogenic HCT was associated with the development of PRES (p=0.019). PRES symptoms were common: hypertension (100%), seizures (79%), nausea/vomiting (50%), altered mental status (50%), and headaches (43%). All received an MRI, and 79% had findings consistent with PRES. The majority (79%) of patients with PRES were admitted to the PICU and 4 (29%) later died. After 2:1 matching, we found that the use of Etoposide (p=0.008) was associated with PRES but comorbidities were not. Conclusion and Implications: While PRES was infrequent in this population, it carries a high morbidity with most requiring PICU admission and a high associated hospital mortality of 29%. The use of etoposide and HCT were associated with PRES.

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

Pediatric Blood & Cancer ◽

10.1002/pbc.27594 ◽

2018 ◽

Vol 66 (5) ◽

pp. e27594 ◽

Cited By ~ 8

Author(s):

Stavroula Anastasopoulou ◽

Mats A. Eriksson ◽

Mats Heyman ◽

Chen Wang ◽

Riitta Niinimäki ◽

...

Keyword(s):

Risk Factors ◽

Acute Lymphoblastic Leukemia ◽

Posterior Reversible Encephalopathy Syndrome ◽

Clinical Characteristics ◽

Lymphoblastic Leukemia ◽

Posterior Reversible Encephalopathy ◽

Reversible Encephalopathy

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Posterior Reversible Encephalopathy Syndrome in a Patient With Microscopic Polyangiitis: A Case Report and Literature Review

Frontiers in Medicine ◽

10.3389/fmed.2021.792744 ◽

2021 ◽

Vol 8 ◽

Author(s):

Jing Xu ◽

Ying Ding ◽

Zhen Qu ◽

Feng Yu

Keyword(s):

Adverse Effect ◽

Posterior Reversible Encephalopathy Syndrome ◽

Clinical Characteristics ◽

Biological Therapy ◽

Microscopic Polyangiitis ◽

Posterior Reversible Encephalopathy ◽

Brain Ct Scan ◽

Reversible Encephalopathy ◽

Regular Hemodialysis ◽

New Onset

Central nervous system (CNS) is rarely involved in microscopic polyangiitis (MPA). Here, we report a 14-year-old girl with MPA who developed new-onset seizures with deterioration of renal function. Her brain CT scan and MRI showed concurrent complications of intracerebral hemorrhage and posterior reversible encephalopathy syndrome (PRES). She got remission with combinations of methylprednisolone pulse, plasma exchange, regular hemodialysis, antiseizure and antihypertension medications. Furthermore, it is crucial to exclude the adverse effect of medications such as corticosteroid and biological therapy. We searched the literatures, retrieved 6 cases of MPA with PRES and summarized their clinical characteristics.

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A study of posterior reversible encephalopathy syndrome in patients with eclampsia

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20201246 ◽

2020 ◽

Vol 9 (4) ◽

pp. 1691

Author(s):

Seeta Garag ◽

Mubashira Janvekar

Keyword(s):

Observational Study ◽

Posterior Reversible Encephalopathy Syndrome ◽

Rural Areas ◽

Clinical Characteristics ◽

Prospective Observational Study ◽

Clinical Profile ◽

Core Component ◽

Posterior Reversible Encephalopathy ◽

Reversible Encephalopathy

Background: The association of posterior reversible encephalopathy syndrome with eclampsia has recently received a lot of attention recently. Advances in Imaging has led to better understanding of the pathophysiology of eclampsia. Present study was undertaken to study the clinical characteristics of patients with eclampsia with PRES.Methods: This is a prospective observational study of 50 cases of Eclampsia with PRES in a period of 1 year. Patients admitted with Eclampsia were subjected to neuroimaging with CT or MRI and those with diagnosis of Posterior Reversible Encephalopathy Syndrome were included in the study and clinical profile analyzed.Results: Total of 50 patients were studied in the period of 1 year. The average age of patients was 21.8 years, majority of them residing in rural areas (74%) and 72% were referred cases.Conclusions: PRES is now identified as core component of Eclampsia. More studies are required to compare the outcome of Eclampsia associated with PRES and without PRES.

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