Kamiya-Matsuoka Carlos, Paker Asif M, Chi Linda, Youssef Ayda, Tummala Sudhakar, Loghin Monica E
Department of Neuro-Oncology, The University of Texas MD Anderson Cancer, 1400 Holcombe Blvd, Room FC7.3000, Unit 431, Houston, TX, 77030, USA.
Department of Neurology, The University of Texas Medical Branch, 301 University Boulevard, Room JSA 9.128, Galveston, TX, 77555, USA.
J Neurooncol. 2016 May;128(1):75-84. doi: 10.1007/s11060-016-2078-0. Epub 2016 Feb 22.
Posterior reversible encephalopathy syndrome (PRES) is a clinico-radiologic entity. Its management and outcome in the oncology population is limited because it is still difficult to identify despite an increasingly recognized occurrence. This is the largest retrospective study of PRES in cancer patients reported from a single institution. We explore the clinical manifestations and radiologic features to comprehensively assess PRES in order to prevent permanent neurologic deficits and mortality. We retrospectively identified 69 patients with cancer who developed PRES at MDACC between 01/2006 to 06/2012. Clinical and radiographic data were abstracted from their records and reviewed for our analysis. Mean age at PRES onset was 52 ± 17.8 years. Fifty-two (75 %; p < 0.001) patients were women. Most common diagnoses were leukemia (30 %) and lymphoma (12 %). Forty-eight (70 %) patients were treated with chemotherapy, 21 (30 %) bone marrow transplant and 14 (20 %) tacrolimus. Most common clinical presentation was seizures (67 %). PRES was associated with hypertension in 62 (90 %) patients. On brain MRI, 33 (44 %) patients had some evidence of hemorrhage, 22 (73 %) of these were thrombocytopenic. Thirty-five (51 %) patients fully recovered and 19 (28 %) had permanent neurological deficits. Morbidity and mortality were associated with continuation with offending agent, thrombocytopenia, variations in mean arterial pressure ≥20 mmHg, electrographic seizures at onset, atypical MRI pattern and delay in diagnostic imaging (7.4 ± 4.8 days vs. 1.9 ± 1.8 days; p = 0.031) as half of them did not receive a prompt intervention. Special attention should be given to patients who present with high-risk factors in order to prevent development of PRES or decrease patient morbidity and mortality. Management of PRES should be guided by the radiographic findings. Overall, early recognition, discontinuation of the offending agents, correction of thrombocytopenia and blood pressure control are still the main strategies to manage PRES.
后部可逆性脑病综合征（PRES）是一种临床放射学实体。由于尽管其发生率日益受到认可，但仍难以识别，因此其在肿瘤患者中的管理和预后情况有限。这是来自单一机构报告的关于癌症患者PRES的最大规模回顾性研究。我们探讨临床表现和放射学特征，以全面评估PRES，从而预防永久性神经功能缺损和死亡。我们回顾性地确定了2006年1月至2012年6月期间在MDACC发生PRES的69例癌症患者。从他们的记录中提取临床和影像学数据并进行审查以用于我们的分析。PRES发病时的平均年龄为52±17.8岁。52例（75%；p<0.001）患者为女性。最常见的诊断是白血病（30%）和淋巴瘤（12%）。48例（70%）患者接受了化疗，21例（30%）接受了骨髓移植，14例（20%）接受了他克莫司治疗。最常见的临床表现是癫痫发作（67%）。62例（90%）患者的PRES与高血压相关。在脑部MRI检查中，33例（44%）患者有一些出血迹象，其中22例（73%）有血小板减少症。35例（51%）患者完全康复，19例（28%）有永久性神经功能缺损。发病率和死亡率与继续使用致病药物、血小板减少症、平均动脉压变化≥20 mmHg、发病时的脑电图癫痫发作、非典型MRI模式以及诊断性影像学检查延迟（7.4±4.8天对1.9±1.8天；p=0.031）相关，因为其中一半患者没有得到及时干预。对于存在高危因素的患者应给予特别关注，以预防PRES的发生或降低患者的发病率和死亡率。PRES的管理应以影像学检查结果为指导。总体而言，早期识别、停用致病药物、纠正血小板减少症和控制血压仍然是管理PRES的主要策略。
