Arterial Hypertension and Posterior Reversible Cerebral Edema Syndrome Induced by Risperidone

Milani, Gregorio P.; Bianchetti, Mario G.; Mazzoni, M.; Triulzi, Fabio; Mauri, Massimo C.; Agostoni, Carlo; Fossali, Emilio F.

doi:10.1542/peds.2013-1301

Cited by 6 publications

(4 citation statements)

References 14 publications

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“…Further, the studies were limited to ≤ 8 weeks and were unable to capture the AEs associated with prolonged use of risperidone. There are reports of additional AEs with prolonged use of risperidone, including iron deficiency anemia, pituitary tumors, hyperprolactinemia, low bone mineral density, arterial hypertension, and posterior reversible cerebral edema syndrome [ 17 – 20 ].…”

Section: Introductionmentioning

confidence: 99%

Adverse Events Associated with Risperidone Use in Pediatric Patients: A Retrospective Biobank Study

Oshikoya

Carroll

Aka

et al. 2019

Drugs - Real World Outcomes

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Background Although risperidone is increasingly used for behavioral indications in children, the associated adverse events (AEs) are not well defined in this population. Objective We determined the incidence of and risk factors for AEs among children treated with risperidone at our institution, an academic medical center with inpatient, outpatient, generalist, and specialist pediatric care. Methods The study included children aged ≤ 18 years with ≥ 4 weeks of risperidone exposure. Data were obtained using de-identified electronic health records. AEs were defined as any untoward event attributed to risperidone reported by the patient, parent/guardian, or physician or detected following a laboratory investigation. Associations between AEs and clinical variables were determined using univariate and multivariate analyses. Results The study cohort included 371 individuals (median age 7.8 years [interquartile range 5.9–10.2]; 271 [73.0%] male). The two most common primary diagnoses were attention-deficit/hyperactivity disorder (160 [43.1%]) and autism (102 [27.5%]). The most frequent indications for risperidone were aggression (166 [44.7%]) and behavioral problems (114 [30.7%]). Altogether, 110 (29.6%) individuals had 156 AEs. Weight gain (32 [20.5%]) and extrapyramidal symptoms (23 [14.7%]) were the most common AEs. Aggression, irritability, and self-injurious behavior were positively associated with AEs, and concomitant analgesics and antibiotics were negatively associated. In multivariate analysis, associations remained significant for self-injurious behavior (adjusted odds ratio [aOR] 3.1; 95% confidence interval [CI] 1.7–5.4) and concomitant antibiotics (aOR 0.2; 95% CI 0.1–0.9). Conclusions Nearly one in three children treated with risperidone for ≥ 1 month experienced one or more AEs. Particular vigilance is warranted for children with self-injurious behavior. Electronic supplementary material The online version of this article (10.1007/s40801-019-0151-7) contains supplementary material, which is available to authorized users.

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Section: Introductionmentioning

confidence: 99%

Adverse Events Associated with Risperidone Use in Pediatric Patients: A Retrospective Biobank Study

Oshikoya

Carroll

Aka

et al. 2019

Drugs - Real World Outcomes

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“…It is therefore tempting to assume that, like in immunoglobulin A vasculitis associated with PRES [ 61 ], an infectious precursor may concurrently trigger both a glomerulonephritis and a cerebral vascular dysfunction [ 14 ]. Agents such as calcineurin inhibitors; sirolimus; platinum-containing cancer drugs; angiogenesis inhibitors; and, more rarely, systemic corticosteroids have also been associated with PRES [ 3 ] but none of the patients included in this review were pretreated with the mentioned agents. Very recent data argue for a central role of innate in the pathophysiology of PRES [ 62 ].…”

Section: Discussionmentioning

confidence: 99%

“…A variety of conditions have been implicated as causes of PRES, including among others severe arterial hypertension and both acute and chronic kidney diseases [ 2 ]. Some drugs have also been deemed to cause PRES [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

Posterior reversible leukoencephalopathy syndrome associated with acute postinfectious glomerulonephritis: systematic review

et al. 2021

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Background Kidney diseases are a recognized cause of posterior reversible leukoencephalopathy syndrome, usually abbreviated as PRES. The purpose of this review was to systematically address the association between acute postinfectious glomerulonephritis and PRES. Methods We performed a systematic review of the literature on acute postinfectious glomerulonephritis associated with PRES. The principles recommended by the Economic and Social Research Council guidance on the conduct of narrative synthesis and on the Preferred Reporting Items for Systematic Reviews and Meta-analyses were used. Databases searched included Excerpta Medica, US National Library of Medicine, and Web of Science. Results For the final analysis, we evaluated 47 reports describing 52 cases (32 males and 20 females). Fifty patients were ≤ 18 years of age. Blood pressure was classified as follows: normal-elevated (n = 3), stage 1 hypertension (n = 3), stage 2 hypertension (n = 5), and severe hypertension (n = 41). Acute kidney injury was classified as stage 1 in 32, stage 2 in 16, and stage 3 in four cases. Neuroimaging studies disclosed a classic posterior PRES pattern in 28 cases, a diffuse PRES pattern in 23 cases, and a brainstem-cerebellum PRES pattern in the remaining case. Antihypertensive drugs were prescribed in all cases and antiepileptic drugs in cases presenting with seizures. A resolution of clinical findings and neuroimaging lesions was documented in all cases with information about follow-up. Conclusions The main factor associated with PRES in acute postinfectious glomerulonephritis is severe hypertension. Prompt clinical suspicion, rapid evaluation, and management of hypertension are crucial. Graphical abstract A higher resolution version of the Graphical abstract is available as Supplementary information

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“…A sudden rise in blood pressure is probably the most common cause. It can induce disruption of cerebral vascular auto-regulation, mostly in the posterior cerebral vasculature, causing leakage of fluid into the brain parenchyma [6-10]. Indeed a gradual blood pressure control is recommended to avoid cerebral hypoperfusion and increased morbidity [11].…”

Section: Discussionmentioning

confidence: 99%

Severe and isolated headache associated with hypertension as unique clinical presentation of posterior reversible encephalopathy syndrome

et al. 2014

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BackgroundPosterior reversible encephalopathy syndrome is a potentially reversible clinicoradiologic syndrome characterized by headache, mental confusion, visual disturbances and seizures associated with posterior cerebral lesions on radiological imaging. Prompt treatment of this condition is mandatory to avoid severe irreversible complications.Case presentationWe report a 9-year-old boy with arterial hypertension and headache as unique clinical presentation of posterior reversible encephalopathy syndrome.ConclusionsSevere and isolated headache associated with arterial hypertension can be the unique clinical presentation of posterior reversible encephalopathy syndrome. This syndrome must be considered even in absence of all typical symptoms to prevent the progression of a potentially life threatening condition.

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Arterial Hypertension and Posterior Reversible Cerebral Edema Syndrome Induced by Risperidone

Cited by 6 publications

References 14 publications

Adverse Events Associated with Risperidone Use in Pediatric Patients: A Retrospective Biobank Study

Adverse Events Associated with Risperidone Use in Pediatric Patients: A Retrospective Biobank Study

Posterior reversible leukoencephalopathy syndrome associated with acute postinfectious glomerulonephritis: systematic review

Severe and isolated headache associated with hypertension as unique clinical presentation of posterior reversible encephalopathy syndrome

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