Long-term evaluation of neurological outcomes in chemotherapy-associated posterior reversible encephalopathy (PRES) syndrome in children

Abstract

Background Posterior reversible encephalopathy syndrome (PRES) is a clinical syndrome with numerous etiologies, mostly characterized by magnetic resonance imaging (MRI) abnormalities in the posterior cerebral white and gray matter and acute neurological symptoms.

Aim To examine the predisposing factors, clinical results, and radiological features of PRES in children diagnosed with malignancy. Materials and

Methods The study included 20 patients (7 F/13 M) aged 4–16 years at the time of diagnosis who were diagnosed with malignancy and developed PRES during chemotherapy.

Results All the patients were diagnosed as having PRES both clinically and radiographically during chemotherapy. The time from the initiation of the chemotherapy to the onset of PRES ranged from 7–675 days. Hypertension was detected in nine patients, seizure was the most common presenting symptom – had involvement in the occipital and parietal lobes on MRI (n=14)/followed by headache (n=8)/altered consciousness (n=5)/visual impairment (n=4). Hydrocephalus and tentorial herniation were observed in one patient. Most of the lesions on MRI resolved within 10–33 days and the EEG findings within 9 months. Clinical symptoms of PRES also disappeared completely the 5-year Press frequency was found to be 2.48%.

Conclusion PRES may complicate the oncological treatment in children. Hypertension is a leading risk factor for PRES, while it should be kept in mind that the blood pressure may be normal in chemotherapy-induced PRES cases. PRES should be included in the differential diagnosis of all patients receiving chemotherapy and presenting with acute neurological symptoms.

Zusammenfassung

Das posteriore reversible Enzephalopathiesyndrom (PRES) ist ein klinisches Syndrom mit zahlreichen Ursachen, das meist durch Anomalien der Magnetresonanztomographie (MRT) in der hinteren weißen und grauen Substanz des Gehirns und akute neurologische Symptome gekennzeichnet ist. Untersuchung der prädisponierenden Faktoren, klinischen Ergebnisse und radiologischen Merkmale von PRES bei Kindern mit diagnostizierter Malignität. Die Studie umfasste 20 Patienten (7 F/13 M) im Alter von 4–16 Jahren zum Zeitpunkt der Diagnose, bei denen eine bösartige Erkrankung diagnostiziert wurde und die während der Chemotherapie PRES entwickelten. Bei allen Patienten wurde sowohl klinisch als auch radiologisch während der Chemotherapie PRES diagnostiziert. Die Zeitspanne vom Beginn der Chemotherapie bis zum Einsetzen von PRES lag zwischen 7 und 675 Tagen. Bei neun Patienten wurde Bluthochdruck festgestellt, Krampfanfälle waren das am häufigsten auftretende Symptom – mit Beteiligung der Hinterhaupts- und Scheitellappen im MRT (n=14)/gefolgt von Kopfschmerzen (n=8)/Bewusstseinsveränderungen (n=5)/Sehbehinderung (n=4). Bei einem Patienten wurden Hydrozephalus und Tentoriumherniation beobachtet. Die meisten Läsionen im MRT verschwanden innerhalb von 10–33 Tagen und die EEG-Befunde innerhalb von 9 Monaten. Die klinischen Symptome von PRES verschwanden ebenfalls vollständig; die 5-Jahres-Pressfrequenz betrug 2,48%. PRES kann die onkologische Behandlung bei Kindern erschweren. Bluthochdruck ist ein führender Risikofaktor für PRES, wobei zu bedenken ist, dass der Blutdruck in chemotherapiebedingten PRES-Fällen normal sein kann. PRES sollte in die Differentialdiagnose aller Patienten einbezogen werden, die eine Chemotherapie erhalten und akute neurologische Symptome aufweisen.

Keywords

posterior reversible encephalopathy (PRES) - chemotherapy-associated - children - neurological outcome

Schlüsselwörter

posteriore reversible Enzephalopathie (PRES) - Chemotherapie-assoziiert - kinder - neurologisches Ergebnis

Publication History

Article published online:
20 December 2024

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