Department of Internal Medicine, Wright State University School of Medicine, Dayton, Ohio, USA.
Intern Med J. 2009 Dec;39(12):826-34. doi: 10.1111/j.1445-5994.2008.01829.x. Epub 2008 Nov 3.
Reversible posterior leucoencephalopathy syndrome (RPLS) is an underappreciated clinical-radiologic syndrome characterized by reversible cortical dysfunction preferentially involving the occipital lobes in conjunction with imaging findings of reversible subcortical oedema. As RPLS is being increasingly identified within the oncology population in association with cytotoxic chemotherapy and targeted agents, a review of the published work in English was carried out.
A MEDLINE search of the published work in English was conducted to identify cases of RPLS in patients more than 16 years of age who were treated with anticancer drugs for documented malignancy. Only cases with adequate documentation regarding demographic and treatment data, cerebral magnetic resonance imaging and outcome were selected.
We identified 24 patients with RPLS associated with a variety of anticancer drugs, most commonly complicating polychemotherapy and/or bevacizumab-containing regimens. There was a female predominance: 18 females and 6 males (P= 0.023). Women were of premenopausal age and were younger than males: 49.3 +/- 16.4 years versus 60.7 +/- 6.4 years (P= 0.09). Most patients presented with acute headache (67%), seizures (63%), confusion (54%) or cortical blindness (46%) with mean systolic and diastolic blood pressure of 168 +/- 15 and 98 +/- 15 mm Hg, respectively. Findings on magnetic resonance imaging showed hyperintense lesions on T(2)-weighted images in all patients, which involved the occipital lobes in 75% of patients; all patients experienced clinical and radiologic resolution within days to weeks. No deaths were directly attributed to RPLS.
Combination and single-agent chemotherapy as well as novel anticancer drugs are associated with RPLS. We found RPLS to be overrepresented in premenopausal woman; the prevalence in this subgroup may be related to an anticancer drug-oestrogen interaction inducing altered cerebral vasoreactivity and endothelial dysfunction.
可逆性后部脑白质病变综合征（RPLS）是一种未被充分认识的临床-放射学综合征，其特征为皮质功能障碍可逆，优先累及枕叶，同时伴有皮质下水肿的影像学表现。由于 RPLS 在接受细胞毒性化疗和靶向药物治疗的肿瘤患者中越来越多地被发现，因此对英语文献进行了综述。
通过 MEDLINE 对英语文献进行了检索，以确定年龄超过 16 岁、接受抗癌药物治疗已确诊恶性肿瘤的患者中发生 RPLS 的病例。仅选择了那些有充分的人口统计学和治疗数据、脑磁共振成像和结局记录的病例。
我们确定了 24 例与各种抗癌药物相关的 RPLS 病例，最常见的是化疗联合或不联合贝伐珠单抗治疗。女性明显多于男性（18 例女性，6 例男性；P=0.023）。女性处于绝经前年龄，且比男性年轻：49.3±16.4 岁比 60.7±6.4 岁（P=0.09）。大多数患者以急性头痛（67%）、癫痫发作（63%）、意识模糊（54%）或皮质盲（46%）为首发症状，平均收缩压和舒张压分别为 168±15 和 98±15mmHg。磁共振成像上所有患者均显示 T2 加权图像上的高信号病变，75%的患者病变累及枕叶；所有患者的临床和影像学表现均在数天至数周内缓解。没有死亡直接归因于 RPLS。
联合化疗和单药化疗以及新型抗癌药物均与 RPLS 相关。我们发现 RPLS 在绝经前女性中更为常见；该亚组的患病率可能与抗癌药物-雌激素相互作用导致脑血管反应性和内皮功能改变有关。
