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Posterior reversible encephalopathy syndrome in cancer patients: a single institution retrospective study

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Abstract

Posterior reversible encephalopathy syndrome (PRES) is a clinico-radiologic entity. Its management and outcome in the oncology population is limited because it is still difficult to identify despite an increasingly recognized occurrence. This is the largest retrospective study of PRES in cancer patients reported from a single institution. We explore the clinical manifestations and radiologic features to comprehensively assess PRES in order to prevent permanent neurologic deficits and mortality. We retrospectively identified 69 patients with cancer who developed PRES at MDACC between 01/2006 to 06/2012. Clinical and radiographic data were abstracted from their records and reviewed for our analysis. Mean age at PRES onset was 52 ± 17.8 years. Fifty-two (75 %; p < 0.001) patients were women. Most common diagnoses were leukemia (30 %) and lymphoma (12 %). Forty-eight (70 %) patients were treated with chemotherapy, 21 (30 %) bone marrow transplant and 14 (20 %) tacrolimus. Most common clinical presentation was seizures (67 %). PRES was associated with hypertension in 62 (90 %) patients. On brain MRI, 33 (44 %) patients had some evidence of hemorrhage, 22 (73 %) of these were thrombocytopenic. Thirty-five (51 %) patients fully recovered and 19 (28 %) had permanent neurological deficits. Morbidity and mortality were associated with continuation with offending agent, thrombocytopenia, variations in mean arterial pressure ≥20 mmHg, electrographic seizures at onset, atypical MRI pattern and delay in diagnostic imaging (7.4 ± 4.8 days vs. 1.9 ± 1.8 days; p = 0.031) as half of them did not receive a prompt intervention. Special attention should be given to patients who present with high-risk factors in order to prevent development of PRES or decrease patient morbidity and mortality. Management of PRES should be guided by the radiographic findings. Overall, early recognition, discontinuation of the offending agents, correction of thrombocytopenia and blood pressure control are still the main strategies to manage PRES.

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References

  1. Hinchey J, Chaves C, Appignani B et al (1996) A reversible posterior leukoencephalopathy syndrome. N Engl J Med 334(8):494–500

    Article  CAS  PubMed  Google Scholar 

  2. Casey SO, Sampaio RC, Michel E, Truwit CL (2000) Posterior reversible encephalopathy syndrome: utility of fluid-attenuated inversion recovery MR imaging in the detection of cortical and subcortical lesions. AJNR Am J Neuroradiol 21(7):1199–1206

    CAS  PubMed  Google Scholar 

  3. Bartynski WS, Boardman JF (2007) Distinct Imaging Patterns and Lesion Distribution in Posterior Reversible Encephalopathy Syndrome. AJNR Am J Neuroradiol 28(7):1320–1327

    Article  CAS  PubMed  Google Scholar 

  4. Bartynski WS, Grabb BC, Zeigler Z et al (1997) Watershed imaging features and clinical vascular injury in cyclosporin a neurotoxicity. J Comput Assist Tomogr 21(6):872–880

    Article  CAS  PubMed  Google Scholar 

  5. Kwon EJ, Kim SW, Kim KK, Seo HS, do Kim Y (2009) A case of gemcitabine and Cisplatin associated posterior reversible encephalopathy syndrome. Cancer Res Treat 41(1):53–55

    Article  PubMed  PubMed Central  Google Scholar 

  6. Connolly RM, Doherty CP, Beddy P, O’Byrne K (2007) Chemotherapy induced reversible posterior leukoencephalopathy syndrome. Lung Cancer 56(3):459–463

    Article  PubMed  Google Scholar 

  7. Ocvirk J, Boc M, Rebersek M, Ros T (2009) Cisplatin-induced non-convulsive posterior reversible encephalopathy syndrome in a 41-year-old woman with metastatic malignant melanoma. Radiol Oncol 43(2):120–125

    Article  CAS  Google Scholar 

  8. Bartynski WS, Zeigler Z, Spearman MP et al (2001) Etiology of cortical and white matter lesions in cyclosporin-A and FK-506 neurotoxicity. AJNR Am J Neuroradiol 22(10):1901–1914

    CAS  PubMed  Google Scholar 

  9. Shah-Khan FM, Pinedo D, Shah P et al (2007) Reversible posterior leukoencephalopathy syndrome and anti-neoplastic agents: a review. Oncol Rev 1(3):152–161

    Article  Google Scholar 

  10. Bartynski WS (2008) Posterior reversible encephalopathy syndrome, part 1: fundamental imaging and clinical features. AJNR Am J Neuroradiol 29(6):1036–1042

    Article  CAS  PubMed  Google Scholar 

  11. Schwartz RB, Bravo SM, Klufas RA et al (1995) Cyclosporine neurotoxicity and its relationship to hypertensive encephalopathy: CT and MR findings in 16 cases. AJR Am J Roentgenol 165(3):627–631

    Article  CAS  PubMed  Google Scholar 

  12. Allen JA, Adlakha A, Bergethon PR (2006) Reversible posterior leukoencephalopathy syndrome after bevacizumab/FOLFIRI regimen for metastatic colon cancer. Arch Neurol 63(10):1475–1478

    Article  PubMed  Google Scholar 

  13. Kamba T, McDonald DM (2007) Mechanisms of adverse effects of anti-VEGF therapy for cancer. Br J Cancer 96(12):1788–1795

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Rajasekhar A, George TJ Jr (2007) Gemcitabine-induced reversible posterior leukoencephalopathy syndrome: a case report and review of the literature. Oncologist 12(11):1332–1335

    Article  CAS  PubMed  Google Scholar 

  15. Kapiteijn E, Brand A, Kroep J, Gelderblom H (2007) Sunitinib induced hypertension, thrombotic microangiopathy and reversible posterior leukencephalopathy syndrome. Ann Oncol 18(10):1745–1747

    Article  CAS  PubMed  Google Scholar 

  16. Henderson RD, Rajah T, Nicol AJ, Read SJ (2003) Posterior leukoencephalopathy following intrathecal chemotherapy with MRA-documented vasospasm. Neurology 60(2):326–328

    Article  CAS  PubMed  Google Scholar 

  17. Tam CS, Galanos J, Seymour JF, Pitman AG, Stark RJ, Prince HM (2004) Reversible posterior leukoencephalopathy syndrome complicating cytotoxic chemotherapy for hematologic malignancies. Am J Hematol 77(1):72–76

    Article  CAS  PubMed  Google Scholar 

  18. Hammerstrom AE, Howell J, Gulbis A et al (2013) Tacrolimus-associated posterior reversible encephalopathy syndrome in hematopoietic allogeneic stem cell transplantation. Am J Hematol 88(4):301–305

    Article  CAS  PubMed  Google Scholar 

  19. Wong R, Beguelin GZ, de Lima M et al (2003) Tacrolimus-associated posterior reversible encephalopathy syndrome after allogeneic haematopoietic stem cell transplantation. Br J Haematol 122(1):128–134

    Article  CAS  PubMed  Google Scholar 

  20. Zeigler ZR, Shadduck RK, Nemunaitis J, Andrews DF, Rosenfeld CS (1995) Bone marrow transplant-associated thrombotic microangiopathy: a case series. Bone Marrow Transplant 15(2):247–253

    CAS  PubMed  Google Scholar 

  21. Schwartz RB, Jones KM, Kalina P et al (1992) Hypertensive encephalopathy: findings on CT, MR imaging, and SPECT imaging in 14 cases. AJR Am J Roentgenol 159(2):379–383

    Article  CAS  PubMed  Google Scholar 

  22. Strandgaard S, Olesen J, Skinhoj E et al (1973) Autoregulation of brain circulation in severe arterial hypertension. BMJ 1(5852):507–510

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. Delanty N, Vaughan C, Frucht S, Stubgen P (1997) Erythropoietin associated hypertensive posterior leukoencephalopathy. Neurology 49(3):686–689

    Article  CAS  PubMed  Google Scholar 

  24. Hugonnet E, Da Ines D, Boby H et al (2013) Posterior reversible encephalopathy syndrome (PRES): features on CT and MR imaging. Diagn Interv Imaging 94(1):45–52

    Article  CAS  PubMed  Google Scholar 

  25. Dinsdale HB (1983) Hypertensive encephalopathy. Neurol Clin 1(1):3–16

    CAS  PubMed  Google Scholar 

  26. Short PF, Vasey JJ, Tunceli K (2005) Employment pathways in a large cohort of adult cancer survivors. Cancer 103(6):1292–1301

    Article  PubMed  Google Scholar 

  27. Li Y, Gor D, Walicki D et al (2012) Spectrum and potential pathogenesis of reversible posterior leukoencephalopathy syndrome. J Stroke Cerebrovasc Dis 21(8):873–882

    Article  PubMed  Google Scholar 

  28. Bhatt A, Farooq MU, Majid A, Kassab M (2009) Chemotherapy-related posterior reversible leukoencephalopathy syndrome. Nat Clin Pract Neurol 5(3):163–169

    Article  CAS  PubMed  Google Scholar 

  29. Liman TG, Bohner G, Heuschmann PU et al (2012) The clinical and radiological spectrum of posterior reversible encephalopathy syndrome: the retrospective Berlin PRES study. J Neurol 259(1):155–164

    Article  CAS  PubMed  Google Scholar 

  30. Munoz J, Kumar V, Hamilton J et al (2013) Posterior reversible encephalopathy syndrome: more than meets the eye. J Clin Oncol 31(20):360–363

    Article  Google Scholar 

  31. Aradillas E, Arora R, Gasperino J (2011) Methotrexate-induced posterior reversible encephalopathy syndrome. J Clin Pharm Ther 36(4):529–536

    Article  CAS  PubMed  Google Scholar 

  32. Lee VH, Wijdicks EFM, Manno EM et al (2008) Clinical Spectrum of Reversible Posterior Leukoencephalopathy Syndrome. Arch Neurol 65(2):205–210

    Article  PubMed  Google Scholar 

  33. Vaughn C, Zhang L, Schiff D (2008) Reversible posterior leukoencephalopathy syndrome in cancer. Curr Oncol Rep 10(1):86–91

    Article  PubMed  Google Scholar 

  34. Bartynski WS (2008) Posterior reversible encephalopathy syndrome, part 2: controversies surrounding pathophysiology of vasogenic edema. AJNR Am J Neuroradiol 29(6):1043–1049

    Article  CAS  PubMed  Google Scholar 

  35. Legriel S, Pico F, Azoulay E (2011) Understanding posterior reversible encephalopathy syndrome. Annu Updat Intensiv Care Emerg Med 2011(26):631–653

    Article  Google Scholar 

  36. Seet RCS, Rabinstein AA (2012) Clinical features and outcomes of posterior reversible encephalopathy syndrome following bevacizumab treatment. QJM 105(1):69–75

    Article  CAS  PubMed  Google Scholar 

  37. Chen YH, Huang CH (2012) Reversible posterior leukoencephalopathy syndrome induced by vinorelbine. Clin Breast Cancer 12(3):222–225

    Article  PubMed  Google Scholar 

  38. Sharief U, Perry DJ (2009) Delayed reversible posterior encephalopathy syndrome following chemotherapy with oxaliplatin. Clin Colorectal Cancer 8(3):163–165

    Article  CAS  PubMed  Google Scholar 

  39. Ozcan C, Wong SJ, Hari P (2006) Reversible posterior leukoencephalopathy syndrome and bevacizumab. N Engl J Med 354(9):980–982

    Article  PubMed  Google Scholar 

  40. Kwon S, Koo J, Lee S (2001) Clinical spectrum of reversible posterior leukoencephalopathy syndrome. Pediatr Neurol 24(5):361–364

    Article  CAS  PubMed  Google Scholar 

  41. Kastrup O, Diener HC (1997) Granulocyte-stimulating factor filgrastim and molgramostim induced recurring encephalopathy and focal status epilepticus. J Neurol 244(4):274–275

    Article  CAS  PubMed  Google Scholar 

  42. Kamiya-Matsuoka C, Cachia D, Olar A, Armstrong TS, Gilbert MR (2014) Primary brain tumors and posterior reversible encephalopathy syndrome. Neuro Oncol Pract 1(4):184–190

    Article  Google Scholar 

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Acknowledgments

The authors thank Jill Delsigne PhD for her assistance with English language and scientific terms.

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No Core Grant is used for any work related to this manuscript.

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Authors and Affiliations

  1. Department of Neuro-Oncology, The University of Texas MD Anderson Cancer, 1400 Holcombe Blvd, Room FC7.3000, Unit 431, Houston, TX, 77030, USA

    Carlos Kamiya-Matsuoka, Asif M. Paker, Sudhakar Tummala & Monica E. Loghin

  2. Department of Neurology, The University of Texas Medical Branch, 301 University Boulevard, Room JSA 9.128, Galveston, TX, 77555, USA

    Carlos Kamiya-Matsuoka & Asif M. Paker

  3. Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1459, Houston, TX, 77030, USA

    Linda Chi & Ayda Youssef

  4. Department of Diagnostic Radiology, Children’s Cancer Hospital/National Cancer Institute, Cairo University, Al Kasr Al Aini, Misr Al Qadimah, Cairo Governorate, Egypt, 57357

    Ayda Youssef

Authors
  1. Carlos Kamiya-Matsuoka
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  2. Asif M. Paker
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  3. Linda Chi
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Correspondence to Carlos Kamiya-Matsuoka.

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Kamiya-Matsuoka, C., Paker, A.M., Chi, L. et al. Posterior reversible encephalopathy syndrome in cancer patients: a single institution retrospective study. J Neurooncol 128, 75–84 (2016). https://doi.org/10.1007/s11060-016-2078-0

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  • DOI: https://doi.org/10.1007/s11060-016-2078-0

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