title: Posterior Reversible Encephalopathy Syndrome in Patients With Cancer.
abstract: BACKGROUND
  Posterior reversible encephalopathy syndrome (PRES) is characterized by neurologic symptoms with typical lesions on neuroimaging and may be associated with chemotherapy and immunosuppressive agents used in patients with cancer. We described the spectrum of PRES at a major cancer center.
  
  
  METHODS
  We reviewed charts of adults with PRES between 2005 and 2011 at Memorial Sloan Kettering Cancer Center for clinical information and outcome.
  
  
  RESULTS
  We identified 21 women (68%) and 10 men (median cohort age: 58 years). Solid tumors (n = 22, 71%) were more common than hematologic (n = 8) or primary brain malignancies (n = 1). Prior brain irradiation (16%) and central nervous system metastases (10%) were uncommon. There were 55% who received chemotherapy or targeted therapy within the month preceding PRES, including 6 patients who received bevacizumab; PRES followed allogeneic stem cell transplantation in 5 (16%). Presenting symptoms included confusion (71%), seizure (58%), and headache (48%). Maximum systolic and diastolic blood pressures were similar among patients grouped by cancer type, chemotherapy or bevacizumab use, and atypical imaging. Moreover, 37% of patients with both magnetic resonance imaging (MRI) and computed tomography (CT) had normal CT concurrent with PRES on MRI, and 84% returned to neurologic baseline at a median of 7.5 days (range: 1-167 days) from onset. Successful anticonvulsant taper was achieved in 51%. Chemotherapy rechallenge was attempted in 41% without recurrent PRES. Autopsy revealed nonspecific changes isolated to radiographically affected areas in one of two patients.
  
  
  CONCLUSIONS
  Recent chemotherapy, particularly bevacizumab, is common in cancer patients with PRES. Clinical and radiographic presentations may vary; MRI appears more sensitive than CT. Anticonvulsant taper and chemotherapy rechallenge is often possible.
  
  
  CONCLUSIONS
  Posterior reversible encephalopathy syndrome is characterized by neurologic symptoms with typical lesions on neuroimaging and may be associated with chemotherapy and immunosuppressive agents used in patients with cancer. Clinical and radiographic presentations are protean, and magnetic resonance imaging is more sensitive than computed tomography. Recovery is common, and many patients can be successfully rechallenged with the apparently offending chemotherapy agent or regimen.
authors.affiliation: Departments of Neurology, Epidemiology and Biostatistics, and Pathology, Memorial Sloan Kettering Cancer Center, New York, New York, USA.
authors.forename: Samuel
authors.initials: S
authors.lastname: Singer
authors.affiliation: Departments of Neurology, Epidemiology and Biostatistics, and Pathology, Memorial Sloan Kettering Cancer Center, New York, New York, USA.
authors.forename: Christian
authors.initials: C
authors.lastname: Grommes
authors.affiliation: Departments of Neurology, Epidemiology and Biostatistics, and Pathology, Memorial Sloan Kettering Cancer Center, New York, New York, USA.
authors.forename: Anne S
authors.initials: AS
authors.lastname: Reiner
authors.affiliation: Departments of Neurology, Epidemiology and Biostatistics, and Pathology, Memorial Sloan Kettering Cancer Center, New York, New York, USA.
authors.forename: Marc K
authors.initials: MK
authors.lastname: Rosenblum
authors.affiliation: Departments of Neurology, Epidemiology and Biostatistics, and Pathology, Memorial Sloan Kettering Cancer Center, New York, New York, USA deangell@mskcc.org.
authors.forename: Lisa M
authors.initials: LM
authors.lastname: DeAngelis
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use; D001794:Blood Pressure; D004569:Electroencephalography; D005260:Female; D006261:Headache / Q000139:chemically induced / Q000209:etiology; D006801:Humans; D053208:Kaplan-Meier Estimate; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications* / Q000401:mortality / Q000503:physiopathology; D054038:Posterior Leukoencephalopathy Syndrome / Q000139:chemically induced / Q000209:etiology* / Q000401:mortality / Q000628:therapy*; D012640:Seizures / Q000188:drug therapy; D014057:Tomography, X-Ray Computed; D055815:Young Adult
keywords: Chemotherapy; Encephalopathy; PRES; Reverse posterior leukoencephalopathy syndrome