Cerebral posterior reversible encephalopathy syndrome in 9 children with hematological diseases

Abstract

Objective To investigate the precipitating factors, clinical manifestations, magnetic resonance imaging (MRI) features and prognoses of children with posterior reversible encephalopathy syndrome (PRES) during the treatment of hematological diseases, and to improve the understanding of the diseases. Methods A total of 9 children with PRES, admitted to our hospital from January 2012 to December 2016, were chosen. The clinical data, including precipitating factors, clinical manifestations, MRI features and prognoses, were retrospectively analyzed. Results (1) Precipitating factors: 6 patients with acute lymphoblastic leukemia occurred PRES during remission induction therapy (6/9, 66.7%) and 3 occurred PRES during oral cyclosporine A after hematopoietic stem cell transplantation or autoimmune diseases (3/9, 33.3%). (2) Clinical manifestations: all of them were acute onset, and the main symptoms were seizures (8/9, 88.9%) and hypertension (7/9, 77.8%); some patients suffered from headache, vomiting, visual disturbances, disturbance of consciousness and poor mental symptoms. (3) Features of head MR imaging: the lesions were mainly located in the parietal-occipital lobe, showing patchy long T1 and long T2 signals, and bilateral imperfect symmetry; FLAIR imaging showed high signal distinctly, and other parts of brain could also been involved in. (4) Prognoses: 7 children (77.8%) recovered well, one (11.1%) left frequent seizures during 2 years of follow up, one (11.1%) left mental retardation. Conclusion Methotrexate, cyclosporine A and other agents are important incentives in children with PRES during the treatment of hematological diseases; seizures and hypertension are the main clinical manifestations; MR imaging is important in diagnosing the disease; and PRES is not completely reversible. Key words: Posterior reversible encephalopathy syndrome; Methotrexate; Cyclosporine A