title: A case report of posterior reversible encephalopathy syndrome in a patient receiving gemcitabine and cisplatin.
abstract: BACKGROUND
  Posterior reversible encephalopathy syndrome (PRES) is a subacute syndrome causing characteristic neurologic and radiologic findings. PRES is predominantly caused by malignant hypertension though it has been associated with immunosuppressive treatments such as chemotherapy.
  
  
  METHODS
  We describe a case of a 58 year old female who developed fluctuant level of consciousness, agitation.
  
  
  METHODS
  MRI findings were in keeping with posterior reversible encephalopathy syndrome following cycle 6 of palliative gemcitabine and cisplatin therapy for metastatic cholangiocarcinoma.
  
  
  METHODS
  The patient was managed with magnesium supplementation for hypomagnesemia and amlodipine.
  
  
  RESULTS
  The patient's level of consciousness returned to normal though she had residual neurologic deficits impairing her ability to drive and impacting her balance.
  
  
  CONCLUSIONS
  Cisplatin is a documented causative agent of PRES though gemcitabine is rarely associated with the syndrome. Combination cisplatin and gemcitabine therapy causing radiologically proven PRES has been documented in only 3 previous case reports. Gemcitabine's poor blood-brain barrier penetration makes it an unlikely culprit of central nervous system (CNS) toxicities. Our case and previous reports suggest higher doses may contribute to CNS toxicities such as PRES. Additionally, an emerging trend of hypomagnesemia associated with PRES has been documented inside and outside the context of malignancy and suggests a possible target for treatment and prevention warranting further investigation.
authors.affiliation: Department of Internal Medicine, University of Alberta, Edmonton, Alberta Cross Cancer Institute, Edmonton, Alberta, Canada.
authors.forename: Hannah
authors.initials: H
authors.lastname: Cherniawsky
authors.forename: Neesha
authors.initials: N
authors.lastname: Merchant
authors.forename: Micheal
authors.initials: M
authors.lastname: Sawyer
authors.forename: Maria
authors.initials: M
authors.lastname: Ho
mesh_terms: D000970:Antineoplastic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D001921:Brain / Q000000981:diagnostic imaging / Q000187:drug effects; D018281:Cholangiocarcinoma / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000601:surgery; D002945:Cisplatin / Q000009:adverse effects* / Q000627:therapeutic use; D003841:Deoxycytidine / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008875:Middle Aged; D054038:Posterior Leukoencephalopathy Syndrome / Q000139:chemically induced* / Q000000981:diagnostic imaging / Q000188:drug therapy; D000093542:Gemcitabine
chemical_list: D000970:Antineoplastic Agents; D003841:Deoxycytidine; D002945:Cisplatin; D000093542:Gemcitabine