Cherniawsky Hannah, Merchant Neesha, Sawyer Micheal, Ho Maria
Department of Internal Medicine, University of Alberta, Edmonton, Alberta Cross Cancer Institute, Edmonton, Alberta, Canada.
Medicine (Baltimore). 2017 Feb;96(8):e5850. doi: 10.1097/MD.0000000000005850.
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.
We describe a case of a 58 year old female who developed fluctuant level of consciousness, agitation.
MRI findings were in keeping with posterior reversible encephalopathy syndrome following cycle 6 of palliative gemcitabine and cisplatin therapy for metastatic cholangiocarcinoma.
The patient was managed with magnesium supplementation for hypomagnesemia and amlodipine.
The patient's level of consciousness returned to normal though she had residual neurologic deficits impairing her ability to drive and impacting her balance.
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.
后部可逆性脑病综合征（PRES）是一种导致特征性神经和影像学表现的亚急性综合征。PRES主要由恶性高血压引起，尽管它也与化疗等免疫抑制治疗有关。
我们描述了一名58岁女性患者，出现意识水平波动、烦躁不安。
对于转移性胆管癌，在接受姑息性吉西他滨和顺铂治疗的第6周期后，MRI检查结果符合后部可逆性脑病综合征。
患者因低镁血症接受了补充镁剂治疗，并使用了氨氯地平。
患者的意识水平恢复正常，尽管仍有残留神经功能缺损，影响其驾驶能力和平衡能力。
顺铂是已记录的PRES致病因素，而吉西他滨很少与该综合征相关。之前仅有3例病例报告记录了联合使用顺铂和吉西他滨治疗导致经影像学证实的PRES。吉西他滨对血脑屏障的穿透性较差，不太可能是中枢神经系统毒性的罪魁祸首。我们的病例及之前的报告表明，更高剂量可能会导致如PRES等中枢神经系统毒性。此外，在恶性肿瘤背景内外均已记录到与PRES相关的低镁血症新趋势，提示这可能是一个治疗和预防的潜在靶点，值得进一步研究。
