scholarly journals Iatrogenic Coagulopathy and the Development of Posterior Reversible Encephalopathy Syndrome after L-asparaginase Chemotherapy

2016 ◽  
Vol 6 ◽  
pp. 7 ◽  
Author(s):  
Eugenia Rota ◽  
Daniele Vallisa ◽  
Nicola Morelli ◽  
Paola Scagnelli
Keyword(s):  
Escherichia Coli ◽  
Renal Failure ◽  
Posterior Reversible Encephalopathy Syndrome ◽  
Antithrombin Iii ◽  
Lymphoblastic Leukemia ◽  
Coagulation Factors ◽  
Immunosuppressive Drugs ◽  
Intrathecal Methotrexate ◽  
Posterior Reversible Encephalopathy ◽  
Reversible Encephalopathy

Posterior reversible encephalopathy syndrome (PRES) is a clinical and radiological syndrome mostly related to hypertension, eclampsia, renal failure, or to chemotherapy and/or immunosuppressive drugs. Although the PRES pathophysiology is multifactorial, hypertension and endothelial dysfunction are hypothesized to be the pivotal factors. Here we report a case of PRES in an adult patient after chemotherapy (Escherichia coliL-asparaginase [L-ASP], daunorubicin, vincristine, and intrathecal methotrexate) for acute lymphoblastic leukemia. The development of the PRES was strictly associated with an iatrogenic coagulopathy induced by L-ASP, which inhibits the biosynthesis of hepatic coagulation factors. The nadir of platelet count, antithrombin III (ATIII) and fibrinogen curve was coincident with the onset of the PRES neurological picture; subsequently, the normalization of the ATIII and fibrinogen levels seemed to parallel the good clinical evolution. This case seems to provide new insights into the PRES pathophysiological mechanisms.

scholarly journals Immunosuppression-associated posterior reversible encephalopathy syndrome in an acute leukemia case

2018 ◽  
Vol 10 (4) ◽  
Author(s):  
Umit Y. Malkan ◽  
Gursel Gunes ◽  
Haluk Demiroglu ◽  
Hakan Goker
Keyword(s):  
Renal Failure ◽  
Acute Renal Failure ◽  
Posterior Reversible Encephalopathy Syndrome ◽  
Lymphoblastic Leukemia ◽  
Immunosuppressive Agents ◽  
Cerebellar Hemisphere ◽  
Hematopoietic Stem ◽  
Posterior Reversible Encephalopathy ◽  
Gvhd Prophylaxis ◽  
Reversible Encephalopathy

Posterior reversible encephalopathy syndrome (PRES) was described in 1996. Herein, we aimed to report an immunosuppression- related PRES case. A 34-year-old woman was diagnosed as t-cell acute lymphoblastic leukemia and allogeneic hematopoietic stem cell transplantation (HSCT) was performed. Cyclosporine was given for GVHD prophylaxis in addition to the other routine medications of HSCT. She was hospitalized for acute renal failure and due to the possible contribution of acute renal failure cyclosporine was stopped. Tacrolimus was started for GVHD prophylaxis at a dose of 1 mg/day. However, fifteen days after the initiation of tacrolimus, blurred vision occurred in our patient. Petechial bleeding sites were detected in bilateral cerebral and cerebellar hemisphere by MR imaging. Tacrolimus dosage was reduced to 0.5 mg/day. She had hypertension which was difficult to control and followed-up in the intensive care unit. She had seizures. Control cranial MR resulted as diffusion limitation in bilateral cerebellar hemisphere, bilateral occipital and frontal-parietal regions with vasogenic edema findings; contrast involvement in left frontal-parietal and right cerebellar regions. She had vision loss and lethargy. Control cranial MR favored PRES syndrome secondary to immunosuppression. Hypertensive state was taken under control with antihypertensive treatment and all immunosuppressive agents were stopped. Two weeks later her clinical condition was slightly improved. MR test which was conducted 2 weeks after the diagnosis revealed the regression of PRES lesions. The characteristic signs on neuroimaging are the symmetrical white matter edema in the posterior cerebral hemispheres, particularly the parietal- occipital regions. In conclusion, PRES rarely develops secondary to the immunosuppressive agents and the clinicians should suspect and promptly diagnose PRES which might cause otherwise serious irreversible clinical complications.

scholarly journals Posterior Reversible Encephalopathy Syndrome: A Case of Hypercalcemia

2018 ◽  
Vol 31 (6) ◽  
pp. 338
Author(s):  
Ana Ponciano ◽  
Vera Vieira ◽  
José Leite ◽  
Célio Fernandes
Keyword(s):  
Renal Failure ◽  
Immunosuppressive Therapy ◽  
Mental Status ◽  
Posterior Reversible Encephalopathy Syndrome ◽  
Altered Mental Status ◽  
Normotensive Patient ◽  
Posterior Reversible Encephalopathy ◽  
Severe Hypercalcemia ◽  
Reversible Encephalopathy

Posterior reversible encephalopathy syndrome is an encephalopathy that can be clinically characterized by headache, altered mental status and/or seizures. Neuroimaging demonstrates usually reversible bilateral subcortical vasogenic occipital-parietal edema. Exact pathophysiology remains unclear but is commonly associated with hypertension, renal failure, sepsis and use of immunosuppressive therapy. Its development in the setting of severe hypercalcemia is extremely rare. The authors report a case of posterior reversible encephalopathy syndrome in a normotensive patient with severe hypercalcemia as the only identifiable cause.

scholarly journals Posterior Reversible Encephalopathy Syndrome Secondary to Cyclophosphamide

2020 ◽  
Author(s):  
E Mohammed ◽  
A Ramrattan ◽  
D Santoriello
Keyword(s):  
Renal Failure ◽  
Autoimmune Diseases ◽  
Posterior Reversible Encephalopathy Syndrome ◽  
Cytotoxic Agents ◽  
Impaired Vision ◽  
Posterior Reversible Encephalopathy ◽  
Hypertensive Emergencies ◽  
Autoimmune Processes ◽  
Reversible Encephalopathy ◽  
New Onset

Posterior reversible encephalopathy syndrome (PRES) is a clinicoradiological diagnosis defined as new onset seizures, headaches, impaired vision and consciousness. PRES is typically associated with hypertensive emergencies and pre-eclampsia but its association with autoimmune diseases is largely multifactorial with the combination of ongoing immunologic processes, sepsis and cytotoxic agents contributing to patient’s presentation. Cyclophosphamide induced PRES is rare and has been reported in cases of patients with renal failure and active autoimmune processes.

scholarly journals Intrathecal Methotrexate-Induced Posterior Reversible Encephalopathy Syndrome (PRES)

2014 ◽  
Vol 31 (1) ◽  
pp. 109-110 ◽  
Author(s):  
Tülay Güler ◽  
Özden Yener Çakmak ◽  
Selami Koçak Toprak ◽  
Seda Kibaroğlu ◽  
Ufuk Can
Keyword(s):  
Posterior Reversible Encephalopathy Syndrome ◽  
Intrathecal Methotrexate ◽  
Posterior Reversible Encephalopathy ◽  
Reversible Encephalopathy

scholarly journals Posterior reversible encephalopathy syndrome (PRES), an acute neurological syndrome due to reversible multifactorial brain edema: a case report

2013 ◽  
pp. 37-42
Author(s):  
Camilla Cicognani ◽  
Chiara Vezzadini ◽  
Stella Battaglia ◽  
Anna F. Marliani ◽  
Roberto Zoni
Keyword(s):  
Case Report ◽  
Posterior Reversible Encephalopathy Syndrome ◽  
Clinical History ◽  
Immunosuppressive Drugs ◽  
Hypertensive Encephalopathy ◽  
Neurological Deficits ◽  
Posterior Reversible Encephalopathy ◽  
Missed Diagnosis ◽  
Reversible Encephalopathy ◽  
Clinical Conditions

Background: The essential features of Posterior Reversible Encephalopathy Syndrome (PRES) are headache, mental changes, seizures, visual symptoms and often arterial hypertension. Brain RMN typically shows cortico-sottocortical parieto-occipital edema, with a bilateral and symmetric distribution. PRES develops in clinical conditions as hypertensive encephalopathy, preeclampsia/ eclampsia, autoimmune diseases, after transplantation, infections and as an adverse effect of immunosuppressive drugs or chemotherapy. It usually completely reverses with treatment, although permanent sequelae are possible in case of delayed or missed diagnosis. Case report: We describe the case of a transsexual (M!F) and tetraplegic patient, admitted for neck and low back pain. She suddenly developed headache, confusion, seizures and severe hypertension with normal blood tests. RMN showed multiple cortico-sottocortical areas of vasogenic and citotoxic edema in temporo-occipital, parietal, frontal, and cerebellar regions. Soon after the beginning of the antihypertensive therapy, clinical recovery was observed, as well as the disappearance of edema at RMN. Discussion and conclusions: Although PRES is usually associated with definite pathological conditions, it is not always the case, as was for the patient here described, who had no predisposing factors in her past clinical history, and presented hypertension only in the acute phase of the syndrome. Since, moreover, PRES usually presents with acute non specific features and it can be misdiagnosed with other serious diseases, the clinician will be helped by the knowledge of this syndrome to promptly start diagnostic workup and treatments, and avoid permanent neurological deficits.

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