Posterior Encephalopathy Syndrome Research Articles

Newly identified adverse events for gemcitabine using the Food and Drug Administration Adverse Event Reporting System

ABSTRACT Background Our research aimed to identify previously undocumented adverse events (AEs) in the gemcitabine drug insert with the goal of informing clinical practice. Methods We extracted adverse events associated with gemcitabine use through 2023 using the Food and Drug Administration Adverse Event Reporting System (FAERS) database. Four algorithms (Reporting Odds Ratio, Proportional Reporting Ratio, Bayesian Confidence Propagation Neural Network, and Empirical Bayesian Geometric Mean) were employed to detect new AE signals. AEs were considered positive signals only if they were detected by all four algorithms. Results From 2014 to 2023, a total of 42,360 AEs were reported in 14,905 individuals following gemcitabine use. These AEs totaled 437 preferred terms (PTs) across 20 system organ classes (SOCs). We identified unexpected AEs related to the ocular disorders, the nervous system, and the ear and the labyrinth. The ocular organ system will present with retinopathy, purtscher retinopathy, choroidal effusion, amaurosis, necrotizing scleritis, etc. The nervous system may experience reversible posterior encephalopathy syndrome, cerebellar syndrome, cauda equina syndrome, athetosis, transverse myelitis, etc. The ears and labyrinth may exhibit ototoxicity. Conclusion Our study identified previously undetected signals following gemcitabine treatment, thereby providing new insights for future medication guidance.

Cerebrovascular Pathologies in Women during Pregnancy and Postpartum In the Neurology Departments of the Yalgado Ouédraogo and Bogodogo University Hospitals

Introduction: Pregnancy and post-partum are periods of risk for cerebrovascular complications in women. These pathologies can affect the vital prognosis of the woman. Objectives: To describe the determinants of cerebrovascular pathologies during pregnancy and postpartum in the neurology departments of the CHU-YO and CHU-B. Method: This was a descriptive cross-sectional study collected retrospectively over a period from January 1, 2019 to December 31, 2021. Results: We included 113 patients, mean age 23.35 years with extremes of 15 and 45 years. Eclampsia predominated in 64.60% of cases. Other etiologies were stroke (18.58%), cerebral venous thrombosis (11.51%), reversible posterior encephalopathy syndrome (3.54%) and reversible cerebral vasoconstriction syndrome (1.77%). Factors associated with the occurrence of cerebrovascular pathology were young age [15-19 years] (p=0.001), high blood pressure (p=0.001). The mortality rate was 8.85%. Conclusion: Cerebrovascular pathologies during pregnancy and postpartum with regard to their morbidity and mortality constitute a reproductive health problem and therefore require a multidisciplinary approach.

Reversible Posterior Encephalopathy Syndrome Secondary to Post-Streptococcal Acute Glomerulonephritis in a Child: About an Unusual Case Report and Review of Literature Oumou Maïga, Marwa El Massi, Moussa Coulibaly, Soumia Mghar, Karima El Fakiri, Nouredine Rada, Ghizlane Draiss, Dounia Basraoui, Mohamed Bouskraoui Published: May 6, 2023 | 7 5 DOI: 10.36347/sasjm.2023.v09i05.007 Pages: 434-426 Downloads Abstract Reversible posterior encephalopathy (PRES) is a

Reversible posterior encephalopathy (PRES) is a clinico-radiological syndrome, which manifests as headaches, confusion, visual disturbances, convulsive seizures and radiological abnormalities of the white substance suggesting oedema of the posterior parieto occipital brain regions. It is a poorly known and very rare disease in children. In a 10-year-old boy with an untreated 15-day history of angina, he presents for headaches, associated with vomiting, or even photophobia-type visual disorders and earache-type otalgia and phonophobia, a disorder of conscience of more than 24 hours without the notion of convulsions and a hematuria in broth dirty. All associated with functional impotent of the lower limbs and meningeal syndrome. Cerebral MRI showed a signal abnormality in cortical subcortical range visible in bilateral parieto-occipital, T2 hypersignal and flair with discrete under cortical restriction of diffusion and not raised after injection. We are bringing a case of reversible posterior encephalopathy secondary to acute glomerulonephritis post-streptococcal associated with a meningeal syndrome that could likely be related to germless bacterial meningitis or meningeal hemorrhage. Early detection and prompt treatment are important measures to reduce morbidity and mortality.

Porphyria-induced Postpartum Reversible Posterior Encephalopathy Syndrome

Acute intermittent porphyria (AIP) is a rare condition that needs to be kept in mind where its early recognition, conservative management, and removal of the precipitating factor are the key factors in its management. This “little imitator” presented with varied symptoms is often misdiagnosed. The diagnosis requires a strong index of suspicion as choosing an antiepileptic medication in the management of seizure requires a judicial choice to avoid precipitation of the underlying illness.How to cite this article: Sharma SR, Sharma N, Synmon B, Hynniewtaya Y. Porphyria-induced Postpartum Reversible Posterior Encephalopathy Syndrome. Indian J Crit Care Med 2022;26(6):728–730.

Clinical Analysis of Childhood Acute Lymphoblastic Leukemia With Epilepsy Seizures.

ObjectiveIn order to analyze the clinical characteristics of epileptic seizures in children with acute lymphoblastic leukemia (ALL) during treatment.MethodsThe clinical and imaging data of children diagnosed as ALL with epilepsy seizures from January 2013 to December 2020 were retrospectively analyzed.ResultsA total of 2217 children with ALL were admitted during the study, of whom 229 (10.33%) had epileptic seizures after ALL treatment. Among them, 45 (19.65%) were in the high-risk group and 184 (80.35%) were in the low-risk group. Epileptic seizures mainly occurred in the induction remission period (24.02%), maintenance treatment period (25.33%) and after bone marrow transplantation (21.40%). The common causes were MTX-related demyelinating encephalopathy (34.06%) and reversible posterior encephalopathy syndrome (PRES) (25.3%). The first symptom was mainly convulsion (34.50%). The first attack had a comprehensive attack and partial attack. Most patients stop themselves. 30 cases (13.10%) had acute recurrence of epilepsy (recurrence within 3 months after the first attack), and 49 cases (25.76%) had neurological dysfunction after follow-up. 36 cases developed symptomatic epilepsy. Among the 130 children who completed the follow-up, 78 (60.00%) had no obvious neurological sequelae, and 52 (40.0%) had neurological sequelae. Among the 52 cases, there were 34 cases of mild sequelae and 18 cases of severe sequelae, including 8 cases of epilepsy combined with cognitive impairment.ConclusionEpileptic seizure is a common neurological complication during ALL treatment. The etiology and associated manifestations of the first epileptic seizure are diverse. Early neuroimaging and EEG examination are helpful for early diagnosis and treatment.

Posterior reversible encephalopathy syndrome in spotted fever group of rickettsial infection with brugada syndrome

Rickettsioses are one of the common causes of undifferentiated febrile illness. Patients present commonly with fever, rash, and eschar. Posterior Reversible Encephalopathy Syndrome (PRES) also known as reversible posterior encephalopathy syndrome is a rare condition, in which parts of the brain are affected by swelling as a result of an underlying cause such as infection. However, PRES caused by spotted fever group of rickettsiosis is rarely reported. We are here with reporting such a case. A 55-year-old male was admitted to MVJ Medical College and Research Hospital, Bengaluru, with complaints of fever for 3 days and one episode of Generalized Tonic Clonic Seizures (GTCS) following which he was in altered sensorium. On examination, there was hepatosplenomegaly. Weil-Felix OX19 and OX2 were 1:320. Lumbar puncture was done which showed 15 cells 98% lymphocytes and 2% neutrophils, proteins-119 mg/dl, and sugar- 153 mg/dl. Magnetic resonance imaging of the brain showed bilateral symmetric hyperintensities on T2-weighted imaging in the parietal and occipital lobes. The calcarine and occipital lobes were spared suggestive of posterior reversible encephalopathy syndrome. Electrocardiogram showed ST elevation in V1 and V2 along with T-wave inversion (Brugada sign). Posterior reversible encephalopathy syndrome is usually commonly seen in hypertensive encephalopathy and in infections such as dengue and few cases of scrub typhus. This is one of the rare cases where spotted fever group of rickettsia has caused posterior reversible encephalopathy syndrome and Brugada syndrome.

Reversible posterior encephalopathy syndrome on malignant hypertension secondary to congenital nephrotic syndrome (case report)

Posterior reversible encephalopathy syndrome (PRES) is a fairly rare complication, and even more so in children. Cerebral magnetic resonance imaging (MRI) is considered the reference examination to evoke this diagnosis. We report the case of a 7-year-old boy presenting with a reversible posterior encephalopathy syndrome secondary to malignant arterial hypertension complicating CKD on congenital nephropathy, which presented with a tonic-clonic seizure and loss of consciousness, with a BP of 190/130mmHg in an apyretic context . Imaging revealed characteristic edema of the white and gray matter in the form of multiple areas of T2 hyper signal and cortico-subcortical cortical temporo-occipital and frontal, of the caudate nucleus and bilateral lenticulars, of the brain stem and cerebellum in relation to the PRES given the clinico radiological context. The course of action was hospitalization in intensive care with stabilization and conditioning, and was put on antihypertensive and anticonvulsant drugs A rigorous monitoring was required in our patient and the evolution was very favorable.

Expression Level of IL-17 in Peripheral Blood of Patients with Late Pregnancy and Diagnosis of Maternal-Fetal Tolerance Based on Brain MRI Image Segmentation Algorithm.

Objectives:To study the expression of IL-17 in peripheral blood and its effect on maternal-fetal tolerance in patients with eclampsia in late pregnancy using MRI image segmentation algorithm.Methods:Thirty-nine patients with severe preeclampsia and eclampsia with brain symptoms were examined by cranial MRI. Pregnant women with 32 weeks of pregnancy were selected to detect the percentage of Th17 and Treg cells in CD4 + T lymphocytes and the expression of cytokines IL-17 and IL-10 in peripheral blood.Results:MRI examination was normal in 26 cases, 9 cases showed reversible posterior encephalopathy syndrome, three cases were cerebral hemorrhage, and one case was intracranial cavernous sinus thrombosis. two. Compared with the mild preeclampsia group, the relative number of Thl7 cells increased and that of Treg cells decreased in the severe preeclampsia group (P>0.05).Conclusion:The major types of cerebrovascular diseases (CVD) in severe preeclampsia and eclampsia were reversible posterior encephalopathy syndrome and cerebral hemorrhage. It was speculated that the damage to the blood-brain barrier may play an important role in the pathogenesis. The balance of the number of Th17 cells/the number of Treg cells was more inclined to the Th17 cell-mediated pro-inflammatory state, Treg cell-mediated immune tolerance decreases, and it becomes more obvious with the worsening of the disease.

Abatacept is effective as GVHD prophylaxis in unrelated donor stem cell transplantation for children with severe sickle cell disease

AbstractWe report results of a phase 1 multicenter stem cell transplantation (SCT) trial from HLA-matched (n = 7) or one-antigen–mismatched (n = 7) unrelated donors (URD) using bone marrow or cord blood as stem cell source, following reduced-intensity conditioning (RIC) in severe sickle cell disease (SCD). Conditioning included distal alemtuzumab, fludarabine, and melphalan (matched donors), with thiotepa (mismatched donors). Abatacept, a selective inhibitor of T cell costimulation, was added to tacrolimus and methotrexate as graft-versus-host disease (GVHD) prophylaxis to offset GVHD risks, and was administered for longer duration in bone marrow recipients than in cord blood recipients because of increased incidence of chronic GVHD with bone marrow. Median age at transplant was 13 years (range, 7-21 years). The incidence of grades II to IV and grades III to IV acute GVHD at day +100 was 28.6% and 7%, respectively. One-year incidence of chronic GVHD was 57% and mild/limited in all but 1 patient who received abatacept for a longer duration. Only 1 patient developed reversible posterior encephalopathy syndrome and recovered. With a median follow-up of 1.6 years (range, 1-5.5 years), the 2-year overall and disease-free survival was 100% and 92.9%, respectively. The encouraging results from the phase 1 portion of this RIC SCT trial, despite risk factors such as older age, URD, and HLA-mismatch, support further evaluation of URD SCT in clinical trial settings. The phase 2 portion of the trial is in progress. This trial was registered atwww.clinicaltrials.govas NCT03128996.

Reversible posterior encephalopathy syndrome induced by drug intoxication: A case report

Posterior reversible encephalopathy syndrome (PRES) is a rare complication of a sudden rise in blood pressure. It is seen in hypertensive patients. It is a clinical–radiological entity characterized by the association of neurological clinical signs and bilateral posterior cerebral edema usually reversible in neuroimaging. According to the literature, it is quite common in adults than in children. The most common causes are hypertensive encephalopathy, renal failure, central nervous system vasculitis, electrolyte disturbances, or when using cytotoxic or immunosuppressive therapies. It is clinically manifested as headache, seizures, coma, or visual disturbances. Imaging plays an undeniable role in the diagnosis and surveillance and cerebral magnetic resonance imaging (MRI) reveals bilateral and asymmetrical lesions affecting the basal ganglia, the left frontal lobe and the parietal lobes, in the form of hyperintensities in sequences. T2 and fluid-attenuated inversion recovery (FLAIR) imaging lead to vasogenic edema. The treatment of the basic pathology is the key to the reversibility of this syndrome. We report this article with the aim of retrieving and demonstrating the interest of imaging as part of a diagnostic approach and monitoring of PRES in a 54-year-old subject followed for schizophrenia and arterial hypertension under neuroleptic treatment having presented seizures with high blood pressure after 10 days of this neuroleptic treatment. The clinical course is favorable without recurrence of crisis with disappearance of the lesions on the imaging of the control after the interruption of the neuroleptics and the normalization of the arterial tension, living and asymptomatic patient on a retreat of one year.

1418P - Clinical features and outcomes of reversible posterior encephalopathy syndrome following bevacizumab treatment

Background: Reversible posterior leukoenchephalopathy syndrome (RPLS), also known as Posterior reversible encephalopathy syndrome (PRES) is a distinct clinicoradiological entity characterized by a constellation of clinical features, and a potentially devastating complication of bevacizumab treatment. Methods: Patients were identified from the published literature using ‘PubMed’ databases using the terms ‘bevacizumab’ or ‘RPLS’ and ‘RPES’ from January 2006 to December 2016, who developed RPLS (RPES) features within 3 weeks of bevacizumab treatment, who had brain imaging findings of focal vasogenic edema and radiologic proof of reversibility. Results: To date, a total of 22 cases of RPLS (PRES) following the administration of bevacizumab have been reported in the literature. The mean age at presentation of these patients was 50 years (range 34–74 years), 6 of whom were male and 14 female. Headaches (n = 11), seizures (n =10), visual disturbances (n = 9) and nausea and vomiting (n = 8) were the common presenting symptoms. In a majority of patients, an increase in blood pressure from their baseline values was observed during their hospitalization. RPLS occurred in 3 patients who received bevacizumab as monotherapy and the rest had received bevacizumab in combination with other chemotherapeutic agents (oxaliplatin, n = 8; fluorouracil, n = 6; leucovorin, n = 5; gemcitabine, n = 3; paclitaxel, n = 3; capecitabine, n = 3; doxorubicin, n = 2; carboplatin, n = 2; and irinotecan, n = 1). In 20 out of 22 patients, PRES resolved following withdrawal of bevacizumab and strict control of blood pressure. 3 patients also received prednisolone and mannitol as part of their treatment for RPLS. However, 2 out of 22 patients could not recover from severe coma, and died. Conclusions: A high level of suspicion for RPLS is advisable in patients who develop headache, seizures, visual disturbances, during bevacizumab treatment, either as monotherapy or in combination with other chemotherapeutic agents. These data support the need for close vigilance of neurological features and blood pressure monitoring of patients undergoing bevacizumab treatment. Prompt withdrawal of bevacizumab and blood pressure control appear to portend favorable outcomes in these patients. Legal entity responsible for the study: OMC-BC Funding: None Disclosure: All authors have declared no conflicts of interest.

Reversible posterior encephalopathy syndrome after allogeneic hematopoietic stem cell transplantation: report of one case and review of literature

目的 探讨单倍体异基因造血干细胞移植术后可逆性后部脑病综合征（RPES）的临床表现、诊治及预后情况。 方法 回顾性分析1例单倍体异基因造血干细胞移植术后合并RPES患者的临床及影像学资料。 结果 该患者诊断为急性淋巴细胞白血病（前B细胞型，WT1阳性），给予诱导化疗、强化治疗后获得完全缓解（CR），后原发病复发，再次完全缓解（CR2）后行单倍体异基因造血干细胞移植。移植后先后出现移植物抗宿主病、血压增高及神经系统症状，结合影像学检查诊断为RPES，经积极治疗后完全恢复，影像学表现迅速改善。 结论 RPES是造血干细胞移植后少见的严重并发症，可由多种病因产生，临床表现及影像学检查具有鲜明的特征，一般预后较好，早发现、早治疗可有效减少中枢神经系统损害。

Posterior encephalopathy syndrome in women with eclampsia: Predictors and outcome.

This study aims to study predictors of posterior encephalopathy syndrome in eclampsia and the impact of posterior encephalopathy syndrome on outcome. This prospective study enrolled consecutive women with eclampsia. These women were subjected to magnetic resonance imaging of the brain. Predictors of posterior encephalopathy syndrome were determined using univariate, followed by multivariate, analysis. Women were followed for 30days. Maternal outcome was assessed using modified Rankin scale (mRS). One hundred and four consecutive women with eclampsia were included. Seventy-four women with eclampsia had posterior encephalopathy syndrome. Predictors of posterior encephalopathy syndrome were primigravida status, altered sensorium, impairment of vision, vomiting, status epilepticus, unregistered status in a regular ante-natal check-up programme, lactate dehydrogenase, uric acid, low platelet count and deranged kidney and liver functions on univariate analysis. On multivariate analysis, vision impairment, primigravida status, and unbooked pregnancy were independent factors. Posterior encephalopathy syndrome was associated with a poor maternal and fetal outcome. Vision impairment, primigravida status, and unbooked pregnancy are independent predictors of posterior encephalopathy syndrome, that in turn is associated with a poor maternal and fetal outcome.

Clinical features and outcomes of reversible posterior encephalopathy syndrome following bevacizumab treatment.

e14045 Background: Reversible posterior leukoenchephalopathy syndrome (RPLS), also known as Posterior reversible encephalopathy syndrome (PRES) is a distinct clinicoradiological entity characterized by a constellation of clinical features, and a potentially devastating complication of bevacizumab treatment. Methods: Patients were identified from the published literature using ‘PubMed’ databases using the terms ‘bevacizumab’ or , ‘RPLS’ and ‘RPES’ from 2006 to 2016, who developed RPLS features within 3 weeks of bevacizumab treatment, who had brain imaging findings of focal vasogenic edema and radiologic proof of reversibility Results: A total of 22 cases of RPLS following the administration of bevacizumab have been reported. The mean age of these patients was 50 years (range 34–74 years), 6 of whom were male and 14 female. Headaches ( n = 11), seizures ( n = 10), visual disturbances ( n = 9) and nausea and vomiting ( n = 8) were the common presenting symptoms. In a majority of patients, an increase in blood pressure from their baseline values was observed during their hospitalization. RPLS occurred in 3 patients who received bevacizumab as monotherapy and the rest had received bevacizumab in combination with other chemotherapeutic agents (oxaliplatin, n = 8; fluorouracil, n = 6; leucovorin, n = 5; gemcitabine, n = 3; paclitaxel, n = 3; capecitabine, n = 3; doxorubicin, n = 2; carboplatin, n = 2; and irinotecan, n = 1). In 20 out of 22 patients, PRES resolved following withdrawal of bevacizumab and strict control of blood pressure. 3 patients also received prednisolone and mannitol as part of their treatment for RPLS. However, 2 out of 22 patients could not recover from severe coma, and died. Conclusions: A high level of suspicion for RPLS is advisable in patients who develop headache, seizures, visual disturbances, during bevacizumab treatment, either as monotherapy or in combination with other chemotherapeutic agents. These data support the need for close vigilance of neurological features and blood pressure monitoring of patients undergoing bevacizumab treatment. Prompt withdrawal of bevacizumab and blood pressure control appear to portend favorable outcomes in these patients.

Reversible posterior encephalopathy syndrome associated with late onset postpartum eclampsia: A case report.

Late onset postpartum eclampsia (LPE) is defined by its onset at >48 h after delivery. Reversible posterior encephalopathy syndrome (RPES) associated with LPE is uncommon, with the majority of RPES cases having a late postpartum onset within 4 weeks after childbirth. The present study reported the case of a 15-year old female presenting with convulsions that began 5 weeks after delivery. A magnetic resonance imaging scan of the brain revealed multiple lesions in the cortex, subcortical region and deep white matter of the bilateral cerebellum, and occipital, frontal and parietal lobes. The clinical manifestations and radiological abnormalities were readily resolved subsequent to antihypertension and anticonvulsion treatment. In conclusion, the present rare case indicates that LPE should be considered as a potential diagnosis even at 4 weeks after delivery. Furthermore, clinicians should familiarize with the reversible radioimaging features of RPES, since early recognition and adequate treatment are important to the outcome of patients.

Reversible posterior encephalopathy syndrome in children with nephrotic syndrome

To investigate the clinical features and prognoses of children who develop reversible posterior encephalopathy syndrome (RPES) during treatment for nephrotic syndrome (NS). The clinicoradiological characteristics and prognoses of 51 patients with NS, including 21 with RPES and 30 without, were analyzed. Compared with the controls, the RPES patients exhibited a higher rate of tacrolimus (P = 0.01) and cyclosporine (P = 0.02) treatment; higher-dose prednisolone (P = 0.01) treatment; higher systolic blood pressure (P = 0.04), serum cholesterol (P = 0.03), and proteinuria (P < 0.01); and lower serum albumin levels (P = 0.03). Hypertension was present in 85.7% of RPES patients. The clinical manifestations of RPES included an altered mental status, seizures, headaches, nausea and vomiting, and visual impairment. Electroencephalography findings included slow waves and focal sharp or/and spiked waves; magnetic resonance imaging showed lesions localized in the occipital, parietal, frontal, temporal lobes and the cerebellum and brainstem; and magnetic resonance angiography revealed vertebral artery narrowing. All RPES patients recovered completely with timely and appropriate therapy. Hypertension, calcineurin inhibitor and high-dose steroid treatments, high serum cholesterol and proteinuria levels, and low serum albumin levels can predispose children with NS to RPES, although both the clinical and imaging outcomes are satisfactory.

Progressive Posterior Encephalopathy Syndrome Related with Drug-refractory Hypertension in a Patient with Pheochromocytoma

Background: Posterior reversible encephalopathy syndrome (PRES) is a neuroradiological syndrome characterized by headache, altered mental status, visual disturbance, and seizures with diagnostic MRI features, especially in the territories of posterior circulation. Reversibility of clinical and radiologic findings is generally regarded as a defining feature of PRES. Case Report: A 72-year old man who had a history of hypertension presented with subacute and progressive visual disturbance, dizziness, limb ataxia, and finally non-convulsive status epilepticus. Magnetic resonance imaging (MRI) showed extensive lesions in bilateral parieto-occipital cortex and subcortex. Due to his marked fluctuation of blood pressure, we detected a pheochromocytoma of left adrenal gland. In spite of administration with several types of antihypertensive medication, the patient presented with clinical deterioration, leading to death. MRI demonstrated the progression of lesions. Conclusion: This case report highlights the clinical and radiological progression of posterior encephalopathy syndrome caused by pheochromocytoma despite appropriate treatment of blood pressure. J Neurocrit Care 2014;7(2):141-144

Progressive Posterior Encephalopathy Syndrome Related with Drug-refractory Hypertension in a Patient with Pheochromocytoma

Progressive Posterior Encephalopathy Syndrome Related with Drug-refractory Hypertension in a Patient with Pheochromocytoma

A 67‐Year‐Old Woman Receiving Tumor Necrosis Factor α Inhibitor Therapy Presenting With Neurologic Dysfunction

A 67‐Year‐Old Woman Receiving Tumor Necrosis Factor α Inhibitor Therapy Presenting With Neurologic Dysfunction

Tacrolimus associated to posterior reversible atypical encephalopathy syndrome and brain haemorrhage in renal transplant recipient.

Tacrolimus associated to posterior reversible atypical encephalopathy syndrome and brain haemorrhage in renal transplant recipient.