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Posterior reversible encephalopathy syndrome in patients with cancer.

2561 Background: The posterior reversible encephalopathy syndrome (PRES) is a clinical-radiologic entity characterized by headache (HA), altered mental function (AMS), seizures and visual loss in association with imaging findings. Here we present the largest retrospective review of clinical manifestations, radiologic features and clinical outcome of PRES in patients with cancer.


METHODS
This retrospective chart-review study identified 29 patients with cancer who developed PRES during their cancer treatment at M.D. Anderson Cancer Center between 01/2006 and 01/2008. Clinical and radiographic data were abstracted from their records.


RESULTS
The average age at the time of PRES onset was 56 (range: 5.8-81 years). Primary diagnoses were leukemia (n=11), melanoma (n=3), lymphoma (n=4), central nervous system tumors (n=4), chondrosarcoma (n=1), multiple myeloma (n=1), prostate (n=1), laryngeal cancer (n=1), gastro-intestinal tumor (n=3) and uterine cancer (n=1). Twenty-two patients (76%) were receiving cancer treatment with chemotherapy and immunosuppressive agents, and 10 patients (34%) received bone marrow transplant. Clinical presentation included seizures n=25 (86%), HA n=14 (48%), AMS n=19 (66%) and vision disturbances n=7 (24%). PRES was associated with hypertension (HTN) in 25 patients (86%). The brain MRI demonstrated T2 signal abnormalities in all patients, restriction diffusion in 3 and hemorrhage in 2. Clinical symptoms fully resolved in 17 patients (65%). Seven patients (24%) remained symptomatic with AMS, headache or visual changes, 4 (13%) patients developed.


CONCLUSIONS
PRES is an increasingly recognized complication of cancer therapy. HTN seems to be the most important trigger for the occurrence of PRES in patients receiving cancer treatment. Incomplete resolution of symptoms, associated cerebral ischemia or hemorrhage with permanent neurological disability highlights the potential grave consequences of this disorder in cancer patients.