Posterior reversible encephalopathy syndrome during management of hematological disorders

Abstract

Background Posterior reversible encephalopathy syndrome (PRES) is a disorder of reversible subcortical vasogenic brain edema with acute neurological symptoms. Diagnosis of PRES is based on exclusion, and treatment consists of symptomatic management. Aims To study the clinical features, radiological findings, and outcomes of PRES in patients with hematological disorders. Patients and methods Case files of patients diagnosed with PRES from January 2016 to November 2019 were reviewed. PRES was diagnosed based on clinical features and MRI findings. Primary diagnosis, clinical history, vital signs, laboratory parameters, treatment summary, and neuroimaging findings were recorded. Results A total of 16 patients were diagnosed with PRES. Their median age was 7 years (range, 2–25 years). A total of 12 patients had acute lymphoblastic leukemia, who were on induction phase, two patients had aplastic anemia, and one each had acute myeloid leukemia and beta-thalassemia major. All patients had hypertension and 15 had seizures as initial presentation of PRES. Overall, 12 patients had bilateral subcortical white matter hyperintensity on T2 in occipital and parietal lobes on MRI. All patient recovered, except one, who had residual neurological deficit. All patients were restarted on the disease therapy once the patients were stabilized. No recurrences were observed. Conclusion Early recognition of PRES may help initiate timely treatment and reduce morbidity and mortality. Implicating agents may be withheld during the symptomatic period. Its management is symptomatic, and therapy may be restarted once patient is clinically stable. Its prognosis is favorable, but some patients may have residual neurological deficit.