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

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.  

Abstract WP220: Can’t Breathe, Can’t See, Can’t Think: Chronic Obstructive Pulmonary Disease Increases the Risk of Posterior Reversible Encephalopathy Syndrome

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Molly Bates ◽  
Kyle Darpel ◽  
Nneka Amadife ◽  
Adam Dugan ◽  
Jessica D Lee
Keyword(s):  
Blood Pressure ◽  
Logistic Regression ◽  
Endothelial Dysfunction ◽  
Posterior Reversible Encephalopathy Syndrome ◽  
Hypertensive Emergency ◽  
Categorical Variables ◽  
Multivariate Logistic Regression ◽  
P Values ◽  
Posterior Reversible Encephalopathy ◽  
Reversible Encephalopathy

Introduction: Several theories exist regarding the pathogenesis of posterior reversible encephalopathy syndrome (PRES). One theory suggests that PRES occurs when systemic blood pressure exceeds the upper limit of cerebral autoregulation. Endothelial dysfunction has been proposed as an alternative pathogenesis to account for PRES outside the setting of acute hypertension. This mechanism has been implicated in other conditions associated with PRES including autoimmune diseases, cytotoxic medications, sepsis, and eclampsia. The purpose of this study was to determine if COPD, a disease known to cause endothelial dysfunction, has a causative association with the development of PRES. Methods: A single center retrospective, age-matched, case-control study was performed from January 2013 to June 2019 comparing patients discharged with a primary diagnosis of PRES to a control group with acute ischemic stroke. Demographics, medical comorbidities, initial blood pressure, and clinical outcomes were compared between the two groups. For categorical variables, p-values were calculated using χ2 and Fisher’s exact tests. For continuous variables, p-values were calculated using two-sample t-tests. The effect of COPD and acute hypoxic respiratory failure on PRES status was investigated using multivariate logistic regression. Results: A total of 94 PRES subjects and 109 control subjects were included for analysis. Mean age did not differ between the two groups; however, the PRES group was more likely to be female (78.7% vs. 49.5%, p<0.001). COPD was present in 26.6% (n=25) of cases and 11% (n= 12) of controls (odds ratio 4.12, p=0.003). Occurrence of hypertension did not differ significantly between the two groups (78.0% vs 86.2%). Among patients with PRES in the setting of COPD (n=25), 60% (n=16) did not meet criteria for hypertensive emergency. Controlling for hypertensive emergency status in a multivariate logistic regression analysis, patients with COPD were 3.21 times more likely to develop PRES (p= 0.004). Conclusions: To our knowledge, very few reports of PRES in the setting of COPD have been described in the literature and no association of PRES and COPD has been defined to date. Our data support the role of COPD as a risk factor in the development of PRES.

scholarly journals Posterior reversible encephalopathy syndrome associated with the use of chemotherapeutic agents: a rare complication after treatment with vinorelbine

2020 ◽  
Vol 13 (2) ◽  
pp. e229319 ◽  
Author(s):  
Ines Gil ◽  
Filipa Serrazina ◽  
Miguel Pinto ◽  
Miguel Viana-Baptista
Keyword(s):  
Blood Pressure ◽  
Posterior Reversible Encephalopathy Syndrome ◽  
Grey Matter ◽  
Rare Complication ◽  
Chemotherapeutic Agents ◽  
Posterior Reversible Encephalopathy ◽  
Parietal Lobes ◽  
Reversible Encephalopathy ◽  
Visual Disturbances

The posterior reversible encephalopathy syndrome (PRES) is a clinicoradiological syndrome characterised by a combination of headache, encephalopathy, seizures and visual disturbances, associated with high-intensity abnormalities on T2-weighted images affecting subcortical white and grey matter of the occipital and parietal lobes. Among other causes, PRES has been associated with the use of several medications including chemotherapeutic agents. Here we report a case of a 65-year-old patient with squamous cell carcinoma of the lung treated with cisplatin/vinorelbine. Following the second administration of vinorelbine, she was admitted to the hospital for a generalised seizure. Blood pressure was just slightly elevated and, except for drowsiness, she had a near-normal neurological examination. MRI corroborated the diagnosis. Vinorelbine-induced PRES has been reported only once in the literature, also in association with cisplatin. Our case underlines the role of vinorelbine and suggests that its association with cisplatin in this setting may enhance the risk of PRES.

Clinical Presentation and Risk Factors for Poor Outcomes Among Adult Patients With Posterior Reversible Encephalopathy Syndrome

2020 ◽  
Vol 25 (6) ◽  
pp. 162-167
Author(s):  
Marcelo G. Vallone ◽  
Carolina Vázquez ◽  
Santiago Pigretti ◽  
Lucrecia L. Oses ◽  
Federico Angriman ◽  
...  
Keyword(s):  
Risk Factors ◽  
Posterior Reversible Encephalopathy Syndrome ◽  
Clinical Presentation ◽  
Adult Patients ◽  
Posterior Reversible Encephalopathy ◽  
Poor Outcomes ◽  
Reversible Encephalopathy

Posterior reversible encephalopathy syndrome in children with cancer

2007 ◽  
Vol 48 (2) ◽  
pp. 152-159 ◽  
Author(s):  
E. Brannon Morris ◽  
Fred H. Laningham ◽  
John T. Sandlund ◽  
Raja B. Khan
Keyword(s):  
Posterior Reversible Encephalopathy Syndrome ◽  
Children With Cancer ◽  
Posterior Reversible Encephalopathy ◽  
Reversible Encephalopathy

scholarly journals Primary brain tumors and posterior reversible encephalopathy syndrome

2014 ◽  
Vol 1 (4) ◽  
pp. 184-190 ◽  
Author(s):  
Carlos Kamiya-Matsuoka ◽  
David Cachia ◽  
Adriana Olar ◽  
Terri S. Armstrong ◽  
Mark R. Gilbert
Keyword(s):  
Brain Tumors ◽  
Posterior Reversible Encephalopathy Syndrome ◽  
Vasogenic Edema ◽  
Diffuse Intrinsic Pontine Glioma ◽  
Chemotherapeutic Agents ◽  
Cancer Center ◽  
Female Ratio ◽  
Posterior Reversible Encephalopathy ◽  
Primary Brain Tumors ◽  
Reversible Encephalopathy

Abstract Background Posterior reversible encephalopathy syndrome (PRES) is a neurotoxic encephalopathic state associated with reversible cerebral vasogenic edema. It is an increasingly recognized occurrence in the oncology population. However, it is very uncommon in patients with primary brain tumors (PBTs). The aim of this study was to analyze the clinicoradiological features and report the clinical outcomes of PRES in PBT patients. Methods We identified 4 cases with PBT who developed PRES at MD Anderson Cancer Center (MDACC) between 2012 and 2014. Clinical and radiological data were abstracted from their records. In addition, we also solicited 8 cases from the literature. Results The median age at PRES onset was 19 years, male-to-female ratio was 1:1, and the syndrome occurred in patients with ependymoma (n = 4), glioblastoma (n = 3), diffuse intrinsic pontine glioma (DIPG; n = 3), juvenile pilocytic astrocytoma (n = 1), and atypical meningioma (n = 1). Two glioblastomas and 2 DIPG cases received bevacizumab and vandetanib before the onset of symptoms, respectively. The most common clinical presentation was seizures (n = 7). Three MDACC patients recovered completely in 3–4 weeks after the onset of symptoms. One patient died due to active cancer and several comorbidities including PRES. Conclusions Hypertension seems to be the most important coexisting risk factor for development of PRES; however, the potential effects of chemotherapeutic agents in the pathogenesis of PRES should also be examined. The clinicoradiological course of PRES in PBT patients did not vary from the classical descriptions of PRES found in other causes. PRES must be considered as part of the differential diagnosis in patients with PBTs presenting with seizures or acute encephalopathy.

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