Chemotherapy-induced posterior reversible encephalopathy syndrome in an adolescent patient with acute lymphoblastic leukemia – A case report

Abstract

Posterior reversible encephalopathy syndrome (PRES) is a clinicoradiological condition characterized by headaches, seizures, confusion, and visual impairment. It typically causes transient lesions in the posterior white matter in magnetic resonance imaging (MRI) of the brain. PRES induced by chemotherapy is uncommon in oncology but can be a significant neurological event. The exact cause of PRES remains unclear. This case report describes a 15-year-old female patient with acute lymphoblastic leukemia who developed PRES following chemotherapy with prednisolone (100 mg), vincristine (2 mg), and daunorubicin (40 mg) as per the modified Berlin-Frankfurt-Munster (95/2002) protocol. She developed headaches, partial seizures, and elevated blood pressure 1 day after starting chemotherapy. Brain MRI showed T2 and fluid-attenuated inversion recovery hyperintensities in the bilateral cerebral parenchyma, brainstem, and cerebellum. She was treated with levetiracetam (500 mg stat and then 1.5 g BD) for seizures, amlodipine (5 mg) for hypertension, and paracetamol (650 mg TDS) for headaches. Her symptoms improved and resolved within 2 days. The event was deemed possibly related to the chemotherapy drugs according to the World Health Organization-Uppsala Monitoring Centre causality assessment system.