Posterior Reversible Encephalopathy Syndrome in Cancer Patients (P06.015)

Abstract

Objective: To explore the clinical manifestations, radiologic features and clinical outcome of posterior reversible encephalopathy syndrome (PRES) in patients with cancer. Background The PRES is a clinical-radiologic entity characterized by headache (HA), altered mental function (AMS), seizures and visual-disturbances in association with imaging findings. Previous literature about the management and outcome of the patients with PRES is limited. Design/Methods: We identified 64 patients with cancer who developed PRES at M.D.Anderson-Cancer-Center between 01/2006 and 06/2011. Clinical and radiographic data were abstracted from their records. Results: The average age at the onset was 52±17.7 years. 44 patients (69%,p=0.003) were women with mean age at onset of 49.6±17.8 years compared to men (mean age at onset 58.8±16 years, p=0.055). Most common cancer diagnoses were leukemia (36%), Lymphoma (9%), gastrointestinal tumors (8%), central-nervous-system tumors (8%). 16 patients (25%) and 35 patients (55%) were treated with tacrolimus and chemotherapy respectively. 22 patients (35%) received bone-marrow transplant (BMT). Clinical presentation included AMS (72%), seizures (69%), HA (33%) and visual-disturbances (19%). PRES was associated with hypertension (HTN) in 57 patients (89%). The brain MRI demonstrated T2 signal abnormalities in all patients and 29 patients (59%) had some evidence of hemorrhage. Seventeen of these 29 patients (59%) were thrombocytopenic. Clinical symptoms fully recovered in 36 patients (57%). Of the 27 (43%) patients with neurological deficits, nine patients (33%) had intracranial hemorrhage and thrombocytopenia, sixteen patients (59%) had a significant delay in diagnostic imaging (11.4±2.5 days versus 1.1±0.3 days, p=0.025) and half of them did not receive a prompt intervention. Conclusions: PRES is an increasingly recognized occurrence in cancer patients undergoing therapy. HTN seems to be the most important co-existent risk factor for development of PRES. Delay in diagnosis can result in permanent residual deficits. Underlying thrombocytopenia in cancer patients with PRES is associated with hemorrhagic complications and increases the risk of incomplete recovery. Disclosure: Dr. Paker has nothing to disclose. Dr. Kamiya Matsuoka has nothing to disclose. Dr. Chi has nothing to disclose. Dr. Loghin has nothing to disclose.