Reversible Posterior Leukoencephalopathy Research Articles

Reversible Posterior Leukoencephalopathy Syndrome Induced by Vinorelbine

Reversible posterior leukoencephalopathy syndrome (RPLS) was first described in 1996; clinical symptoms include the presence of headache, visual disturbance,seizure, hypertension, and encephalopathy. The syndrome is most commonly encountered in association with chemotherapeutic agents or targeted therapy. Many chemotherapeutic agents, such as cisplatin,gemcitabine, methotrexate, were reported to be associated with RPLS. Vinorelbine is commonly used for the treatment of metastatic breast cancer, but vinorelbine-induced RPLS has not been reported. We reported a 34-year-old woman, diagnosed with invasive ductal carcinoma of the left breast, who experienced acute hypertension after vinorelbine intravenous infusion. Accompanied symptoms included headache,seizure, and conscious disturbance. Magnetic resonance imaging of the brain showed symmetric signal hyperintensity with the cortical and subcortical white matter of bilateral frontal, parietal, and occipital (predominant) lobes. Vinorelbine is a semisynthetic vinca alkaloid and prevents cell division by inhibiting tubulin polymerization.Brain metastasis or leptomeningeal carcinomatosis is an important issue for patients with breast cancer who present with headache, seizure, or altered consciousness.However, now RPLS may be a new consideration,especially with the presentation of acute hypertension. Unlike brain or meningeal metastasis, RPLS is usually benign, and most patients recover within 2 weeks. Our case highlights an association between vinorelbine and RPLS, and the drug has not been described as a predisposing factor of RPLS in past reports. In the era of cancer treatment with chemotherapy or targeted therapy,clinicians should be aware of this syndrome.

Reversible Posterior Leukoencephalopathy Syndrome: A Case Presentation

ABSTRACT.Reversible posterior leukoencephalopathy syndrome (RPLS) is encountered in many subspecialty areas of medical practice but is seen relatively infrequently by the neurodiagnostic technologist. There are several different names for this condition including: reversible posterior leukoencephalopathy, reversible posterior leukoencephalopathy syndrome, posterior reversible encephalopathy syndrome, and hypertensive encephalopathy. A brief review of RPLS and the case presentation of a woman who developed eclampsia, temporary blindness, and recurrent seizures captured by EEG/video monitoring are presented in this paper. EEG samples and brain magnetic resonance imaging (MRI) changes related to RPLS are highlighted.

Axitinib: Oral tyrosine kinase inhibitor for renal cell carcinoma

Axitinib: Oral tyrosine kinase inhibitor for renal cell carcinoma

47 REVERSIBLE POSTERIOR LEUKOENCEPHALOPATHY SYNDROME (RPLS) FOLLOWING TRANSFUSION THAT INVOLVED WOMAN WITH CHRONIC ANEMIA DUE TOHUGE UTERINEMYOMA

Transfusion may be necessary in anemic patient. But there are some adverse effects during or after blood transfusion. A 53 year-old-woman who was diagnosed iron deficiency anemia due to huge uterine myoma was transferred from local clinic. Her chief complaint was voiding difficulty, so we underwent total abdominal hysterectomy after correcting low hemoglobin. She developed seizures after receiving 10 units of packed red blood cells. She had no underlying diseases and her blood pressure was normal. Clinical and radiological findings, this patient were diagnosed as reversible posterior leukoencephalopathy syndrome (RPLS). There are some cases of RPLS following transfusion that involved middle-aged women with chronic severe anemia who received large volumes of blood transfusion within a few days. Although blood transfusion is a common procedure with rare neurological complications, great caution should be taken with chronic severely anemic patients because a rapid elevation in hemoglobin may precipitate RPLS.

Reversible Posterior Leukoencephalopathy in the Course of Goodpasture Syndrome

Reversible posterior leukoencephalopathy syndrome (RPLS) is characterized by headache, altered consciousness, seizures, and cortical blindness. The most frequent etiological factors are hypertension, kidney diseases, and immunosuppressive drugs such as steroids and cyclophosphamide. Herein we present a case of a 22-year-old female patient presented with alveolar hemorrhage and acute renal failure necessitating hemodialysis. In renal biopsy, necrotizing crescentic glomerulonephritis and immunofluorescence pattern compatible with Goodpasture syndrome were found. Anti-glomerular basement membrane antibody result was positive. At follow-up, respiratory failure ensued, steroid pulse treatment was started, and she was transferred to intensive care unit (ICU). In the ICU, she had visual disturbances and blindness together with seizures. Cranial magnetic resonance imaging (MRI) revealed irregular T2- and fluid-attenuated inversion recovery (FLAIR)-weighted lesions in bilateral occipital lobes. On clinical and radiological grounds, RPLS was diagnosed. With the supportive and anti-hypertensive treatment, RPLS was resolved without a sequela. Subsequent cranial MRI was totally normal. In the literature, RPLS associated with Goodpasture syndrome was reported only once. Hypertension and methylprednisolone might be the responsible etiologies in this case.

Cisplatin-Induced Posterior Reversible Encephalopathy Syndrome—Brief Report and Review of the Literature

Cisplatin is one of the most broadly used chemotherapeutic agents. Several central nervous system toxicities have been attributed to this agent, among which is a rare clinicoradiological condition referred to as posterior reversible leukoen-cephalopathy syndrome (PRES) or reversible posterior leukoencephalopathy syndrome (RPLS). PRES is characterized by subacute onset of headache, visual disturbances, confusion, seizures and rarely, coma. This usually reversible syn-drome was associated in the past mainly with hypertension. Several reports have associated the syndrome with several immunosuppressive and chemotherapeutic agents suggesting a disruption of the blood brain barrier due to direct damage to the endothelium and vasogenic edema. This syndrome is readily diagnosed with Computed Tomography (CT) or Magnetic resonance imaging (MRI) studies and quick withdrawal of the causative agent in conjunction with supportive care including rapid hypertension control and reduction of elevated intracranial pressure when needed, usually reverse the neurological symptoms with minimal or even no sequela within several days. In this brief report and review of the literature we describe two cases of PRES in two female patients that occurred a few days after receiving Cisplatin-based chemotherapy. We discuss the clinical presentation, diagnosis and treatment of this syndrome by reviewing the literature. The escalating number of clinical reports of PRES merit further studies of the mechanism of toxicity, appropriate treatment and awareness of physicians to this life threatening entity

Reversible Posterior Leukoencephalopathy Syndrome after Carboplatin and Paclitaxel Regimen for Lung Cancer

Reversible posterior leukoencephalopathy syndrome (RPLS) is uncommon neurological syndrome that is characterized by specific clinical and radiologic findings. Previous reported associations of RPLS include hypertension, eclampsia, renal impairment and drugs. Prompt diagnosis and therapy is critical to ensure resolution of the neurological disability. Some cases have been reported in association with the increased use of antineoplastic agents in cancer patients. We report the case of a 62-year-old man who was diagnosed with RPLS after receiving carboplatin and paclitaxel chemotherapy for lung cancer. This case appears to be the first recognized association of RPLS with this regimen.

Panic Attack Induced by Single Dose of Prednisone;Intracranial Hemorrhage after High-Dose Methylprednisolone;Atrial Flutter Associated with Carboplatin Administration;Hyperosmolar Hyperglycemic State Associated with Ziprasidone;DRESS Syndrome Associated with Antibiotic Therapy;Accidental Polydipsia and Hyponatremia from Diphenhydramine;Reversible Posterior Leukoencephalopathy Syndrome (RPLS) Associated with Ustekinumab Therapy

The purpose of this feature is to heighten awareness of specific adverse drug reactions (ADRs), discuss methods of prevention, and promote reporting of ADRs to the US Food and Drug Administration's (FDA's) MedWatch program (800-FDA-1088). If you have reported an interesting, preventable ADR to MedWatch, please consider sharing the account with our readers.

多発性骨髄腫治療中に発症したreversible posterior leukoencephalopathyの1例

症例は50代,女性．多発性骨髄腫（IgG-κ）の治療後再発例で，Cr 1.53mg/dl，eGFR 26.4ml/minと低下あり，重症腎機能障害の投与量に準じてlenalidomide15mg隔日投与にて治療を開始した．Day 19より急激な腎機能障害の進行，意識障害が出現しreversible posterior leukoencephalopathy（RPLS）と診断した．lenalidomide投与を中止し，対症療法にて腎機能，意識レベルは改善した．RPLS発症の原因として腎不全，腫瘍崩壊症候群，lenalidomideの有害事象，多発性骨髄腫が挙げられ，多発性骨髄腫の治療とRPLSの関連性が示唆された．

Reversible Posterior Leukoencephalopathy Syndrome Accompanying Eclampsia: Correct Diagnosis Using Preoperative MRI

Reversible posterior leukoencephalopathy syndrome (RPLS) is characterized by clinical symptoms such as seizures, visual disturbance, and altered mental status. It also presents abnormal findings on computed tomography (CT) and magnetic resonance imaging (MRI) indicating cerebral edema in the white matter of the occipital, temporal, and parietal lobes. Both the clinical symptoms and abnormal imaging findings can be reversed by controlling blood pressure or treating the underlying condition including infection. This report describes a patient with RPLS that occurred secondary to eclampsia. A 26-year-old female, gravida 0 para 0, developed weakness and pain in her upper and lower extremities and gait disturbance during the 34th week of pregnancy, and severe pregnancy-induced hypertension near the end of the 37th week. On the first day of the 38th week, she developed constricted visual fields and complained of visual illusions. MRI revealed a high-signal-intensity area in the right occipital lobe. Immediately after MRI, the patient had a 10-sec tonic convulsion. Diagnosed with eclampsia, she underwent emergency cesarean section. MRI on the 2nd postoperative day showed that the high-signal-intensity area was slightly improved. Her visual illusions were diminished by the 4th postoperative day, and almost all subjective symptoms disappeared by the 7th postoperative day. The patient was discharged at 12th postoperative day. We recommend MRI not only for symptomatic patients with suspected RPLS, but also for asymptomatic patients with severe pregnancy-induced hypertension. If findings such as cerebral edema are observed on MRI, immediate delivery should be considered before eclamptic seizures or exacerbation of neurological symptoms.

Reversible posterior leukoencephalopathy syndrome and anti-neoplastic agents: a review

Reversible Posterior Leukoencephalopathy Syndrome (RPLS) is a well recognized entity with a variety of benign and malignant conditions. Recently it has been found to be associated with the use of anti-neoplastic agents including targeted therapies. RPLS occurs rapidly with the use of some drugs and more slowly with others. Combined therapies are associated with a more frequent and more rapid presentation. This review was based on a literature search for English Language articles concerning RPLS and chemotherapeutic agents published from June 1996 to March 2007. We used the PubMed database with keywords: “RPLS”, “Posterior reversible encephalopathy syndrome”, “(PRES)”, “Chemotherapy” and “MRI”. This syndrome has classical Clinical-Radiologic features that are easy to recognize. Early recognition and withdrawal of the offending agent is all that is needed in most cases. This review highlights the features of the syndrome. It draws our attention to an entity which is being more frequently recognized and whose exact pathologic mechanisms need to be further studied. This syndrome is associated with the use of neurotoxic as well as non-neurotoxic agents and usually runs a benign course if there is an early diagnosis and management.

P1-14-04: Prolonged (≥1 Year) Exposure to First-Line Bevacizumab Combined with Paclitaxel in Patients with HER2−Negative Metastatic Breast Cancer Treated in a Routine Oncology Practice Study.

Abstract Background: First-line bevacizumab (BEV) combined with weekly paclitaxel (PAC) significantly improves progression-free survival (PFS) and response rate (RR) vs PAC alone in HER2−negative metastatic breast cancer (mBC), as shown in E2100. The benefit of BEV combined with other chemotherapy (CT) agents was demonstrated in AVADO and RIBBON-1. BEV was continued for ≥1 year in 21% of patients in the global ATHENA safety study and in 42% of patients in the JO19901 single-arm Japanese study of BEV-PAC. We analyzed data from the subgroup of patients treated for ≥1 year in a German routine oncology practice study to provide insight into the safety and efficacy of prolonged first-line BEV-PAC. Methods: Patients who had received no prior CT for their mBC received BEV-PAC per the European label. Efficacy and safety were documented for up to 1 year (or until progression, death, or BEV discontinuation if earlier) with additional long-term follow-up. Data from patients treated with BEV for ≥1 year were extracted for this analysis. Results: By Jan 2011, data were available for 818 patients, of whom 157 (19%) had already received BEV for ≥1 year. Baseline characteristics of this subset relative to the overall population are summarized in the table. In 79% of those treated for ≥1 year, BEV was continued as a single agent after discontinuation of CT. The overall RR in patients treated for ≥1 year was 81% (complete response in 20%). Median PFS was 17.9 months (events in 44% of patients) vs 9.4 months in the overall population (events in 68%). Overall survival data are immature, as 81% of those treated for ≥1 year are still alive. The most common grade 3/4 adverse events in patients treated with BEV for ≥1 year were hypertension (11% of patients), pain (10%), and leukopenia (7%). There were no cases of gastrointestinal perforation, arterial thromboembolic event, or reversible posterior leukoencephalopathy syndrome in those treated for≥1 year. Analysis of adverse events according to time of onset is ongoing. Conclusions: A notable proportion of patients appear to derive benefit from prolonged exposure to first-line BEV-containing therapy. In the present analysis, baseline characteristics appeared more favorable in the subset of patients treated for ≥1 year than in the overall population. Efficacy data clearly have a bias towards improved outcome in those able to continue BEV for ≥1 year, as these patients had sustained disease control for ≥1 year. However, the efficacy of prolonged BEV-containing therapy is of interest and suggests that some patients achieve sustained disease control with continued first-line BEV-PAC with limited side effects. Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P1-14-04.

高血圧・2型糖尿病の治療自己中断後に発症したbrain stem variant of reversible posterior leukoencephalopathy syndromeの一例

高血圧・2型糖尿病の治療自己中断後に発症したbrain stem variant of reversible posterior leukoencephalopathy syndromeの一例

Is Posterior Reversible Encephalopathy Syndrome Underestimated in Systemic Lupus Erythematosus?

To the Editor: Varaprasad and colleagues described a cohort of reversible encephalopathy in patients with systemic lupus erythematosus (SLE)1. This cohort adds to the increasing evidence that SLE can manifest reversible encephalopathy, e.g., posterior reversible encephalopathy syndrome (PRES)2,3. It is possible that PRES is underestimated in SLE. However, we are concerned about the differential diagnoses of these cases. PRES, also termed reversible posterior leukoencephalopathy syndrome, was initially described by Hinchey, et al … Address correspondence to Dr. Zhang; E-mail: drzhl{at}hotmail.com.

Reversible posterior leukoencephalopathy syndrome after blood transfusion in a patient with end-stage renal disease

A 42-year-old female end-stage renal disease (ESRD) patient with reversible posterior leukoencephalopathy syndrome (RPLS) post-transfusion during initiation of hemodialysis is reported. Eleven days after the onset of illness, we diagnosed encephalopathy as a grand mal seizure resulting from diffuse cerebral edema. One reason for the delayed diagnosis was that her symptom, a throbbing headache that occurred during her first dialysis, indicated dialysis disequilibrium syndrome. We must bear in mind that a small amount of transfusion could cause RPLS even during the first dialysis. To our knowledge, this is the first case report on RPLS after blood transfusion in an ESRD patient.

Bevacizumab-Induced Reversible Posterior Leukoencephalopathy Syndrome and Successful Retreatment in a Patient With Glioblastoma

Bevacizumab-Induced Reversible Posterior Leukoencephalopathy Syndrome and Successful Retreatment in a Patient With Glioblastoma

Nonconvulsive Status Epilepticus Related to Posterior Reversible Leukoencephalopathy Syndrome Induced by Cetuximab

Reversible posterior leukoencephalopathy syndrome (PRES) is a relatively uniform clinical and neuroradiologic manifestation of central nervous system toxicity. The clinical features are headache, altered mental status, and visual disturbances. PRES is often associated with arterial hypertension but it is most usually related to drug toxicity. In fact, it has been related to immunosupressants, cytotoxic, and new antineoplastic-targeted therapies such as sorafenib, sunitinib, bevacizumab, bortezomib, rituximab, and etanercept. We describe a most unusual case of nonconvulsive status epilepticus related to PRES induced by cetuximab in a patient with metastatic squamous cell carcinoma of the penis. This case emphasizes that in any patient receiving treatment with anti-epidermal growth factor receptor agents and showing a compatible clinical syndrome, PRES should be suspected. We also review the clinical and neuroradiologic features of PRES, discuss its' pathogenesis, and highlight the importance of rapid recognition and withdrawal of the causative agent.

Quiz Page September 2011: A Patient With Postpartum Hypertension and Seizure

Quiz Page September 2011: A Patient With Postpartum Hypertension and Seizure

Bupropion-Induced Generalized Exanthematous Pustulosis; Azathioprine-Induced Fever; Reversible Posterior Leukoencephalopathy Syndrome with Sunitinib Therapy; Ketoprofen-Associated Nonalcoholic Fatty Liver Disease and Steatohepatitis; Glomerulosclerosis with Acute Renal Failure Associated with Eltrombopag; Anaphylaxis from Passive Transfer of Peanut Allergen in a Blood Product; Early Detection and Prediction of Cardiotoxicity in Chemotherapy-Treated Patients

The purpose of this feature is to heighten awareness of specific adverse drug reactions (ADRs), discuss methods of prevention, and promote reporting of ADRs to the US Food and Drug Administration's (FDA's) MedWatch program (800-FDA-1088). If you have reported an interesting, preventable ADR to MedWatch, please consider sharing the account with our readers.

Sepsis-Associated Encephalopathy: Review of the Neuropsychiatric Manifestations and Cognitive Outcome

Sepsis-Associated Encephalopathy: Review of the Neuropsychiatric Manifestations and Cognitive Outcome