title: Primary brain tumors and posterior reversible encephalopathy syndrome.
abstract: BACKGROUND
  Posterior reversible encephalopathy syndrome (PRES) is a neurotoxic encephalopathic state associated with reversible cerebral vasogenic edema. It is an increasingly recognized occurrence in the oncology population. However, it is very uncommon in patients with primary brain tumors (PBTs). The aim of this study was to analyze the clinicoradiological features and report the clinical outcomes of PRES in PBT patients.
  
  
  METHODS
  We identified 4 cases with PBT who developed PRES at MD Anderson Cancer Center (MDACC) between 2012 and 2014. Clinical and radiological data were abstracted from their records. In addition, we also solicited 8 cases from the literature.
  
  
  RESULTS
  The median age at PRES onset was 19 years, male-to-female ratio was 1:1, and the syndrome occurred in patients with ependymoma (n= 4), glioblastoma (n= 3), diffuse intrinsic pontine glioma (DIPG;n= 3), juvenile pilocytic astrocytoma (n= 1), and atypical meningioma (n= 1). Two glioblastomas and 2 DIPG cases received bevacizumab and vandetanib before the onset of symptoms, respectively. The most common clinical presentation was seizures (n= 7). Three MDACC patients recovered completely in 3-4 weeks after the onset of symptoms. One patient died due to active cancer and several comorbidities including PRES.
  
  
  CONCLUSIONS
  Hypertension seems to be the most important coexisting risk factor for development of PRES; however, the potential effects of chemotherapeutic agents in the pathogenesis of PRES should also be examined. The clinicoradiological course of PRES in PBT patients did not vary from the classical descriptions of PRES found in other causes. PRES must be considered as part of the differential diagnosis in patients with PBTs presenting with seizures or acute encephalopathy.
authors.affiliation: Department of Neuro-Oncology , The University of Texas MD Anderson Cancer Center , Houston, Texas (C.K.-M., D.C., T.S.A., M.R.G.); Department of Family Health , The University of Texas Health Science Center School of Nursing , Houston, Texas (T.S.A.); Department of Pathology , The University of Texas MD Anderson Cancer Center , Houston, Texas (A.O.).
authors.forename: Carlos
authors.initials: C
authors.lastname: Kamiya-Matsuoka
authors.affiliation: Department of Neuro-Oncology , The University of Texas MD Anderson Cancer Center , Houston, Texas (C.K.-M., D.C., T.S.A., M.R.G.); Department of Family Health , The University of Texas Health Science Center School of Nursing , Houston, Texas (T.S.A.); Department of Pathology , The University of Texas MD Anderson Cancer Center , Houston, Texas (A.O.).
authors.forename: David
authors.initials: D
authors.lastname: Cachia
authors.affiliation: Department of Neuro-Oncology , The University of Texas MD Anderson Cancer Center , Houston, Texas (C.K.-M., D.C., T.S.A., M.R.G.); Department of Family Health , The University of Texas Health Science Center School of Nursing , Houston, Texas (T.S.A.); Department of Pathology , The University of Texas MD Anderson Cancer Center , Houston, Texas (A.O.).
authors.forename: Adriana
authors.initials: A
authors.lastname: Olar
authors.affiliation: Department of Neuro-Oncology , The University of Texas MD Anderson Cancer Center , Houston, Texas (C.K.-M., D.C., T.S.A., M.R.G.); Department of Family Health , The University of Texas Health Science Center School of Nursing , Houston, Texas (T.S.A.); Department of Pathology , The University of Texas MD Anderson Cancer Center , Houston, Texas (A.O.).
authors.forename: Terri S
authors.initials: TS
authors.lastname: Armstrong
authors.affiliation: Department of Neuro-Oncology , The University of Texas MD Anderson Cancer Center , Houston, Texas (C.K.-M., D.C., T.S.A., M.R.G.); Department of Family Health , The University of Texas Health Science Center School of Nursing , Houston, Texas (T.S.A.); Department of Pathology , The University of Texas MD Anderson Cancer Center , Houston, Texas (A.O.).
authors.forename: Mark R
authors.initials: MR
authors.lastname: Gilbert
keywords: bevacizumab; glioblastoma; glioma; posterior reversible encephalopathy syndrome; primary brain tumor