Chemotherapy-induced posterior reversible encephalopathy syndrome

Abstract

Rationale: Posterior reversible encephalopathy syndrome (PRES) has been associated with the use of several medications, including chemotherapeutic agents. Patient concerns: A 65-year-old woman was diagnosed with adenocarcinoma of the ovary, after sixth-line treatment with topotecan, at the beginning of the fourth cycle, she was admitted to the emergency room for presenting tonic-clonic seizures, visual disturbance, and hypertension. A 66-year-old woman was diagnosed with bilateral breast cancer; due to disease progression, treatment with paclitaxel and gemcitabine was started, 1 month after the last dose of chemotherapy, she was admitted to the emergency room for suffering severe headache, altered mental status, tonic-clonic seizures, and hypertension. A 60-year-old patient diagnosed with breast cancer on the left side, underwent second-line chemotherapy with gemcitabine, carboplatin, and bevacizumab, and 1 month after the last dose of chemotherapy, she was also admitted to the emergency room due to altered mental status, vomiting, tonic-clonic seizures, and hypertension. Diagnosis: They were diagnosed as PRES based on physical examination, laboratory findings, and imaging techniques that revealed diffuse lesions and edema within the parieto-occipital regions. Interventions: They received support treatment with blood pressure (BP) control, seizures were controlled with a single anti-epileptic agent, and chemotherapeutic agents from the onset of PRES to its resolution were discontinued. Outcomes: All these patients improved after medical treatment was started. Lessons: Medical personnel and therapeutic establishments need to be made aware about this chemotherapy-induced neurologic complication.

Posterior reversible encephalopathy syndrome in a patient with metastatic breast cancer: A case report

“…PRES has been reported in cancer patients who have undergone chemotherapy of targeted agents[ 6 , 7 ]. However, herein we focused on the pathophysiology found in advanced cancer in a case of PRES in an untreated breast cancer patient.…”

Atypical Posterior Reversible Encephalopathy Syndrome due to Oral Tyrosine Kinase Inhibitor Cabozantinib: First Case Report

“…Chemotherapeutic agents are one of the causes of PRES. There are multiple chemotherapeutic agents that are associated with PRES including taxanes, platinum derivatives, vinca alkaloids, antimetabolites, anthracyclines, angiogenesis inhibitors, folate antagonists, and immunosuppressants [4]. Angiogenesis inhibitors include group of chemotherapeutic agents that block vascular endothelial growth factor (VEGF) function in different ways.…”

Neurologic Complications in Patients with Cancer

“…130 Workup of PRES should include brain MRI; the most common finding is symmetrical T2 hyperintensities in the parietal-occipital white matter (►Table 6). 131 Cancer treatments that have (rarely) been linked to PRES include VEG-F inhibitors (bevacizumab), 130,132 taxanes (paclitaxel), 133,134 platinum derivatives (carboplatin, oxaliplatin), 135 Vinca alkaloids (vincristine), 130,136 and methotrexate. 137 Calcineurin inhibitors (tacrolimus, cyclosporine) used for immune-suppression after bone marrow transplant (BMT) have clearly been associated with PRES.…”