scholarly journals Neurotoxic complications of chemotherapy in children: posterior reversible encephalopathy syndrome

2021 ◽  
Vol 20 (5) ◽  
pp. 50-56
Author(s):  
O. V. Koryakina ◽  
O. P. Kovtun ◽  
L. G. Fechina ◽  
I. S. Tereshchenko ◽  
R. S. Volozhanin
Keyword(s):  
Posterior Reversible Encephalopathy Syndrome ◽  
Clinical Manifestations ◽  
Posterior Reversible Encephalopathy ◽  
Clinical Observations ◽  
Oncological Diseases ◽  
Triggering Factor ◽  
Radiological Aspect ◽  
Medical Histories ◽  
Magnetic Resonance Imaging Mri ◽  
Reversible Encephalopathy

Introduction. The syndrome of posterior reversible encephalopathy syndrome (PRES) is a clinical-radiological condition caused by vasogenic brain edema due to elevated blood pressure. The development of this syndrome is associated with the toxic effect of drugs in the treatment of oncological diseases. In most cases, timely diagnosis and therapy of PRES determine the complete reversibility of symptoms. However, a poor prognosis is possible with the development of severe disabling consequences or death. In practice, there are difficulties in the diagnosis of PRES due to the lack of specificity of clinical manifestations and awareness of many doctors about the existence of this syndrome.The aim of the study was to present the clinical-radiological aspect of the syndrome of posterior reversible encephalopathy in children with oncological diseases.Materials and methods. The analysis of 8 medical histories of children with oncological pathology complicated by the syndrome of posterior reversible encephalopathy was carried out.Results. The study group was dominated by patients with hemato-oncological diseases. The development of PRES occurred during chemotherapy and in most cases was not associated with arterial hypertension. The clinical picture was dominated by such symptoms as impairment of consciousness, seizures and movement disorders in the form of paresis. When carrying out magnetic resonance imaging (MRI), the lesion of the white matter of the brain was determined, mainly in the projection of the parieto-occipital regions. During treatment, all patients showed reversibility of neurological symptoms with leveling of radiological signs.Discussion. When analyzing the clinical and radiological characteristics of PRES in children, a comparison of the data with clinical observations presented in the literature was noted. The role of chemotherapy as a triggering factor in the development of posterior reversible encephalopathy syndrome has been determined.Conclusion. The necessity of including the syndrome of posterior reversible encephalopathy in the list of differential diagnoses in patients receiving chemotherapy is shown.

scholarly journals Eclampsia-Induced Posterior Reversible Encephalopathy Syndrome in a Donor Oocyte Recipient

2021 ◽  
Author(s):  
Jesús Garcia Castro ◽  
Jorge Rodríguez-Pardo ◽  
Javier Díaz de Terán
Keyword(s):  
Posterior Reversible Encephalopathy Syndrome ◽  
Vasogenic Edema ◽  
Illustrative Case ◽  
Posterior Reversible Encephalopathy ◽  
Donor Oocyte ◽  
Oocyte Fertilization ◽  
Emergency Cesarean ◽  
Hypertensive Disorders In Pregnancy ◽  
Magnetic Resonance Imaging Mri ◽  
Reversible Encephalopathy

Objective: Posterior reversible encephalopathy syndrome (PRES) has been robustly associated with preeclampsia, hyperperfusion or endothelial dysfunction suggested as possible mechanisms. In this article, we report an illustrative case of this complication in a patient with risk factors for hypertensive disorders in pregnancy, including advanced maternal age and donor oocyte fertilization. Case report: We present a case of a 40-year-old pregnant, donor oocyte recipient with sudden decreased visual acuity accompanied by hypertension, proteinuria and tonic-clonic seizures. Magnetic resonance imaging (MRI) of the brain showed bilateral lesions in the parieto-occipital regions suggestive of vasogenic edema, leading us to suspect posterior reversible encephalopathy syndrome. The patient underwent an emergency cesarean section and labetalol and magnesium sulfate were administered intravenously. The neurological symptoms and radiological findings resolved following delivery and the patient’s blood pressure normalized, supporting the diagnosis of posterior reversible encephalopathy syndrome. Conclusion: Pregnancy by donor oocyte fertilization may entail a higher risk of eclampsia and associated posterior reversible encephalopathy syndrome.  

scholarly journals Posterior reversible encephalopathy syndrome following appendicitis in a young child: A case report and review of the pediatric literature

2021 ◽  
Vol 9 ◽  
pp. 2050313X2110534
Author(s):  
Yaseen Rafee ◽  
Ruba Allabwani ◽  
Tala Haddadin ◽  
Ahmad Kaddurah
Keyword(s):  
Posterior Reversible Encephalopathy Syndrome ◽  
Vasogenic Edema ◽  
Clinical Manifestations ◽  
Brain Magnetic Resonance Imaging ◽  
Altered Mental Status ◽  
Visual Disturbance ◽  
Complicated Appendicitis ◽  
Posterior Reversible Encephalopathy ◽  
Severe Infections ◽  
Reversible Encephalopathy

Posterior reversible encephalopathy syndrome is an acute or subacute neurological disorder with variable clinical manifestations including encephalopathy, headache, seizures, visual disturbance, and focal neurologic deficits. Neuroimaging often shows frequently reversible vasogenic edema that predominantly involves the subcortical parieto-occipital lobes. Posterior reversible encephalopathy syndrome has been associated with hypertension and reported in patients with many conditions including eclampsia/pre-eclampsia and immunosuppressive therapy. Recently, posterior reversible encephalopathy syndrome is recognized to occur in association with severe infections such as complicated appendicitis. Here, we describe a case of 11-year-old male admitted for complicated appendicitis and severe sepsis. He developed seizures and had an altered mental status 10 days into his hospitalization with brain magnetic resonance imaging findings consistent with posterior reversible encephalopathy syndrome. We review the pediatric literature and discuss the pathogenesis of posterior reversible encephalopathy syndrome in association with an infection. We highlight the importance of recognizing this syndrome as a possible cause for acute neurological deterioration in children with severe infections.

scholarly journals Posterior reversible encephalopathy syndrome mimicking cerebral metastasis: contraindication for biopsy

2014 ◽  
Vol 4 (1) ◽  
Author(s):  
Dukagjin Morina ◽  
Georgios Ntoulias ◽  
Homajoun Maslehaty ◽  
Martin Scholz ◽  
Athanasios K. Petridis
Keyword(s):  
Posterior Reversible Encephalopathy Syndrome ◽  
Resonance Imaging ◽  
Open Biopsy ◽  
Posterior Reversible Encephalopathy ◽  
Typical Appearance ◽  
Magnetic Resonance Imaging Mri ◽  
Immunosupressive Therapy ◽  
Reversible Encephalopathy ◽  
Radiologic Features

The posterior reversible encephalopathy syndrome (PRES) is a well described entity of white matter pathology. PRES is triggered by numerous different factors such as acute elevated arterial hypertension, immunosupressive therapy, chemotherapy, etc. The case of a 67-year old woman is presented. The patient was treated for breast cancer 10 months ago and because of acute disorientation a magnetic resonance imaging (MRI) was performed. In the MRI biparieto-occipital hyperintense lesions were seen. Brain metastases were suspected. After chemothe - rapy and hypertonia and the typical appearance of the lesions in the MRI, PRES was also suspected. Before initializing the surgery for an open biopsy a follow-up MRI had been performed (2 weeks after initial MRI). In follow-up MRI the lesions disappeared completely proving the diagnosis of PRES. PRES can be misdiagnosed as a tumour and surgery could be mistakenly performed. It’s important to keep the differential diagnosis of PRES in mind when radiologic features of the syndrome are present.

scholarly journals Posterior Reversible Encephalopathy Syndrome in a Patient with Hemorrhagic Fever with Renal Syndrome

2020 ◽  
Vol 2020 ◽  
pp. 1-5
Author(s):  
Ermira Muco ◽  
Amela Hasa ◽  
Arben Rroji ◽  
Arta Kushi ◽  
Edmond Puca ◽  
...  
Keyword(s):  
Posterior Reversible Encephalopathy Syndrome ◽  
Supportive Therapy ◽  
Hemorrhagic Fever ◽  
Elisa Test ◽  
Albumin Level ◽  
Hantavirus Infection ◽  
Posterior Reversible Encephalopathy ◽  
Magnetic Resonance Imaging Mri ◽  
Reversible Encephalopathy ◽  
Physical Findings

We presently report the case of hantavirus infection in a 45-year-old male who was hospitalized to our clinic of infectious diseases, with fever, myalgia, vomiting, nausea, headache, and abdominal pain. The physical findings included hepatomegaly, splenomegaly, rash, and conjunctival injection. Eight days before the start of complaints, the patient has cut trees in the mountain. An acute renal failure was observed with an oliguria and an increase of serum creatinine and blood urea nitrogen. Urinalysis shows albuminuria and hematuria. Elevations of amylase, lipase, and liver enzymes levels, low serum albumin level, and thrombocytopenia were observed. A positive ELISA test for hantavirus IgM/IgG antibodies confirmed hemorrhagic fever with renal syndrome. On the third day of hospitalization, the patient had seizures. The unenhanced head computed tomography (CT) performed after seizures showed subcortical bilateral hypodensities within frontal, parietal, and occipital regions corresponding to areas of increased signal intensity in magnetic resonance imaging (MRI) associated with cerebral edema in posterior reversible encephalopathy syndrome (PRES). The treatment consisted of supportive therapy. The patient underwent another head MRI with contrast enhancement after 2 months, which resulted normal.

scholarly journals Posterior Reversible Encephalopathy Syndrome and Azathioprine

2019 ◽  
Author(s):  
Sara Pinto Teixeira Vilas-Boas ◽  
Ana Corte-Real
Keyword(s):  
Magnetic Resonance Imaging ◽  
Status Epilepticus ◽  
White Matter ◽  
Posterior Reversible Encephalopathy Syndrome ◽  
Severe Hypertension ◽  
Neurological Manifestations ◽  
Resonance Imaging ◽  
Posterior Reversible Encephalopathy ◽  
Magnetic Resonance Imaging Mri ◽  
Reversible Encephalopathy

Posterior reversible encephalopathy syndrome (PRES) is a rare syndrome that presents with neurological manifestations, often associated with arterial hypertension. Magnetic resonance imaging (MRI) shows bilateral white matter oedema in the posterior vascular territories. Immunosuppression, (pre) eclampsia and autoimmune diseases can be implicated. A 27-year-old woman, with mixed connective tissue disease under azathioprine, was admitted in the emergency room in status epilepticus and with severe hypertension. The MRI showed bilateral oedema in a pattern compatible with PRES. There was clinical improvement after azathioprine suspension. PRES is typically reversible with prompt recognition of the syndrome and its trigger. The association with azathioprine is rare.

scholarly journals Malignant Posterior Reversible Encephalopathy Syndrome—An Exacting Challenge for Neurocritical Care Physicians

2017 ◽  
Vol 7 (4) ◽  
pp. 196-199 ◽  
Author(s):  
Shahvaiz Magsi ◽  
Atif Zafar
Keyword(s):  
Posterior Reversible Encephalopathy Syndrome ◽  
Neurocritical Care ◽  
Bowel Resection ◽  
Resonance Imaging ◽  
Posterior Reversible Encephalopathy ◽  
Magnetic Resonance Imaging Mri ◽  
Reversible Encephalopathy ◽  
Resolution Of Imaging ◽  
Tomography Scan ◽  
Caucasian Female

We report a case of malignant posterior reversible encephalopathy syndrome (PRES) in a 62-year-old Caucasian female with a complex medical history and comorbidities admitted for bowel resection and lysis of iatrogenic bowel adhesions and enterocutaneous fistulas. Postoperatively, the patient developed sudden bilateral visual loss with no other neurologic deficits. Computed tomography scan showed very severe PRES-like changes, confirmed on magnetic resonance imaging (MRI). Systolic blood pressure remained around 170 mm HG. The patient was obtunded and remained unresponsive after MRI, with minimal response and a deteriorating clinical condition. The patient was given hyperosmolar therapy with a mannitol bolus. She recovered well with near resolution of imaging findings.

scholarly journals A Rare Case of Cyclophosphamide-Induced Posterior Reversible Encephalopathy Syndrome in a Patient with Anti-GBM Vasculitis, and Review of Current Literature

2019 ◽  
Vol 2019 ◽  
pp. 1-5 ◽  
Author(s):  
Taha Nisar ◽  
Abdul R. Alchaki ◽  
Erin Feinstein
Keyword(s):  
Posterior Reversible Encephalopathy Syndrome ◽  
Sinus Thrombosis ◽  
Altered Mental Status ◽  
Cerebral Venous Sinus Thrombosis ◽  
Clinical Syndrome ◽  
Posterior Reversible Encephalopathy ◽  
Posterior Leukoencephalopathy ◽  
Vessel Imaging ◽  
Magnetic Resonance Imaging Mri ◽  
Reversible Encephalopathy

Posterior reversible encephalopathy syndrome (PRES) is a clinical syndrome of headache, altered mental status, and seizures with reversible mainly posterior leukoencephalopathy on neuroimaging. Precipitating factors for PRES are multifactorial and include autoregulatory failure due to changes in blood pressure, metabolic derangements, and cytotoxic medications. We report the second case of cyclophosphamide-induced PRES in a patient with anti-glomerular basement membrane (Anti-GBM) positive vasculitis. In the acute setting, PRES can be challenging to distinguish from cerebral venous sinus thrombosis or cerebral vasculitis based on clinical presentation. Neuroimaging with magnetic resonance imaging (MRI) of the brain along with a vessel imaging, can help reach the diagnosis.

Posterior reversible encephalopathy syndrome (PRES): presentation, diagnosis and treatment

2020 ◽  
Vol 96 (1140) ◽  
pp. 623-628 ◽  
Author(s):  
Anant Parasher ◽  
Rajat Jhamb
Keyword(s):  
Posterior Reversible Encephalopathy Syndrome ◽  
Clinical Symptoms ◽  
Positive Outcome ◽  
Neurological Deficits ◽  
Posterior Reversible Encephalopathy ◽  
Mri Scans ◽  
Blood Pressures ◽  
Magnetic Resonance Imaging Mri ◽  
Reversible Encephalopathy ◽  
Visual Disturbances

Posterior reversible encephalopathy syndrome (PRES) is a neurological disorder which is characterised by variable symptoms, which include visual disturbances, headache, vomiting, seizures and altered consciousness. The exact pathophysiology of PRES has not been completely explained, but hypertension and endothelial injury seem to be almost always present. Vasoconstriction resulting in vasogenic and cytotoxic edema is suspected to be responsible for the clinical symptoms as well as the neuro-radiological presentation. On imaging studies, Symmetrical white matter abnormalities suggestive of edema are seen in the computer tomography (CT) and magnetic resonance imaging (MRI) scans, commonly but not exclusively in the posterior parieto-occipital regions of the cerebral hemispheres. The management is chiefly concerned with stabilization of the patient, adequate and prompt control of blood pressure, prevention of seizures and timely caesarean section in obstetric cases with pre-eclampsia/eclampsia. In conclusion, persistently elevated blood pressures remain the chief culprit for the clinical symptoms as well as the neurological deficits. Early diagnosis by diffusion weighted MRI scans, and differentiation from other causes of altered sensorium i.e. seizures, meningitis and psychosis, is extremely important to initiate treatment and prevent further complications. Although most cases resolve successfully and carry a favorable prognosis, patients with inadequate therapeutic support or delay in treatment may not project a positive outcome.

scholarly journals Guillain-Barre syndrome with concurrent posterior reversible encephalopathy syndrome and hyponatraemia: mere coincidence or rare coexistence

2019 ◽  
Vol 12 (7) ◽  
pp. e229749 ◽  
Author(s):  
Carley Drye ◽  
Subhasish Bose ◽  
Samata Pathireddy ◽  
Narothama Reddy Aeddula
Keyword(s):  
Back Pain ◽  
Posterior Reversible Encephalopathy Syndrome ◽  
Clinical Manifestations ◽  
Guillain Barre Syndrome ◽  
Posterior Reversible Encephalopathy ◽  
Persistent Symptoms ◽  
Guillain Barré Syndrome ◽  
History Of ◽  
Guillain Barré ◽  
Reversible Encephalopathy

A 61-year-old Caucasian woman with a history of hypertension presented with a week’s history of confusion falls and back pain was found to have hyponatraemia from secretion of antidiuretic hormone and treated appropriately. Given her persistent symptoms, despite a normal CT head on presentation, an MRI head was obtained, showing vasogenic oedema in line with posterior reversible encephalopathy syndrome (PRES). Despite aggressive antihypertensives and supportive measures, unfortunately, her condition deteriorated, with increased confusion, new left-sided flaccid paresis, paraesthesias and worsening of the back pain. Following further testing including a cerebrospinal fluid analysis, finally diagnosed with an atypical presentation of Guillain-Barre syndrome (GBS), and prompt management with intravenous immunoglobulins was initiated. She recovered clinically and returned to near-normal function on follow-up. We use this case to suggest the importance of dysautonomia in GBS and various clinical manifestations it can present with, including PRES and hyponatraemia.

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