Posterior reversible encephalopathy syndrome: a possible late interaction between cytotoxic agents and general anaesthesia.
A 49-year-old woman who had previously received treatment with cytotoxic drugs for metastatic gestational trophoblastic disease (GTD) presented with a witnessed tonic-clonic seizure, headache, confusion and blindness, 6 days after the uneventful administration of a general anaesthetic and 2 months after cessation of chemotherapy. Magnetic resonance imaging showed relatively symmetrical, subcortical, white matter abnormalities, predominantly affecting the occipital, posterior temporal and parietal lobes and the cerebellum. T2-dependent abnormalities and elevated regional apparent diffusion coefficient were present in a pattern typical for posterior reversible encephalopathy syndrome (PRES). The clinical and radiological manifestations were resolved completely with supportive therapy. This case of PRES may be a late complication of gemcitabine or cisplatin therapy precipitated by a general anaesthetic, or associated electrolyte or blood pressure disturbance.
Department of Imaging, Charing Cross Hospital, Fulham Palace Road, London, UK.
P S
PS
Rangi
W J
WJ
Partridge
E S
ES
Newlands
A D
AD
Waldman
D000768:Anesthesia, General / Q000009:adverse effects*; D000964:Antimetabolites, Antineoplastic / Q000009:adverse effects* / Q000627:therapeutic use; D001794:Blood Pressure; D001921:Brain / Q000473:pathology*; D001927:Brain Diseases / Q000209:etiology*; D003841:Deoxycytidine / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D038524:Diffusion Magnetic Resonance Imaging; D005260:Female; D031901:Gestational Trophoblastic Disease / Q000188:drug therapy; D006801:Humans; D008875:Middle Aged; D011247:Pregnancy; D013577:Syndrome; D014882:Water-Electrolyte Balance; D000093542:Gemcitabine
D000964:Antimetabolites, Antineoplastic; D003841:Deoxycytidine; D000093542:Gemcitabine