Ann Oncol (2011) 22 (2): 472-478.
doi: 10.1093/annonc/mdq382
First published online: August 10, 2010
Posterior reversible encephalopathy syndrome in childhood cancer
P. de Laat1,†, M. L. te Winkel1,†, A. S. Devos2, C. E. Catsman-Berrevoets3, R. Pieters1 and M. M. van den Heuvel-Eibrink1,*
+ Author Affiliations
1Department of Pediatric Oncology/Hematology
2Department of Pediatric Radiology
3Department of Pediatric Neurology, Erasmus MC-Sophia Children’s Hospital, University Medical Center, Rotterdam, The Netherlands
*Correspondence to: Dr M. M. van den Heuvel-Eibrink, Department of Pediatric Oncology/Hematology, Erasmus MC-Sophia Children’s Hospital, University Medical Center, Dr. Molewaterplein 60, 3015 GJ Rotterdam, The Netherlands. Tel: +31 10 703 6691; Fax: +31 10 703 6801, E-mail: m.vandenheuvel@erasmusmc.nl
Received March 12, 2010.
Accepted May 26, 2010.
Abstract
Background: Posterior reversible encephalopathy syndrome (PRES) is characterized by seizures, headaches, altered mental status, cortical blindness and typical transient lesions on magnetic resonance imaging.
Patients and methods: We describe seven childhood cancer patients with clinical and radiological symptoms of PRES, and reviewed all well-documented PRES cases reported during childhood cancer treatment.
Results: Fifty-six children with PRES, including our 7 cases, were identified in the literature. Mean age at onset was 9 (range: 2–17) years. Primary diagnoses were acute lymphoblastic leukemia (n = 31), acute myeloid leukemia (n = 5), non-Hodgkin lymphoma (n = 7) and solid tumors (n = 13). PRES patients presented with seizures (n = 50), altered mental status (n = 20), visual disturbances (n = 24) and/or headaches (n = 17). PRES was associated with hypertension in 49 patients. About 86% of the patients had both clinical and radiological reversible symptoms. Four patients developed epilepsy, in one patient ataxia remained and one patient had a persistent mydriasis.
Conclusion: Although PRES has predominantly been described in leukemia patients, it occurs in children with solid tumors as well. Hypertension seems to be the most important trigger for the occurrence of PRES during childhood cancer treatment. Seizures are the most common accompanying sign. Symptoms and radiological findings normalize in ∼90% of the cases, but in 10% neurological symptoms remain.
Posterior reversible encephalopathy syndrome in childhood cancer — Ann Oncol
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