Ishihara Masashi, Matsutani Noriyuki, Ota Shuji, Seki Nobuhiko
aDivision of Medical Oncology, Department of Internal Medicine, Teikyo University School of Medicine, Itabashi, Japan.
bDepartment of Surgery, Teikyo University School of Medicine, Itabashi, Japan.
Case Rep Oncol. 2017 Mar 9;10(1):235-238. doi: 10.1159/000460244. eCollection 2017 Jan-Apr.
This report presents the case of a 60-year-old woman who was diagnosed with stage IV lung adenocarcinoma with asymptomatic brain metastases and commenced chemotherapy with cisplatin/pemetrexed (CDDP/Pem). She experienced tonic-clonic convulsions on day 9 of the first cycle, which were accompanied by increased blood pressure (173/69 mm Hg) and headache. Therefore, brain MRI was performed to check for stroke or progression of brain metastatic foci. T2-weighted, FLAIR, and ADC map images showed high-intensity areas in the subcortical region of the bilateral parieto-occipital lobes, leading to a diagnosis of posterior reversible encephalopathy syndrome (PRES). The symptoms improved after treatment with antihypertensive and antiepileptic drugs. Clinicians should keep it in mind that central nervous system symptoms during anticancer therapy containing Pem may indicate possible PRES.
本报告介绍了一名60岁女性的病例，该患者被诊断为IV期肺腺癌伴无症状脑转移，并开始接受顺铂/培美曲塞（CDDP/Pem）化疗。在第一个周期的第9天，她出现了强直阵挛性惊厥，伴有血压升高（173/69 mmHg）和头痛。因此，进行了脑部MRI检查以排查中风或脑转移灶进展情况。T2加权、FLAIR和ADC图图像显示双侧顶枕叶皮质下区域有高强度区域，从而诊断为后部可逆性脑病综合征（PRES）。经抗高血压和抗癫痫药物治疗后症状有所改善。临床医生应牢记，在含培美曲塞的抗癌治疗期间出现的中枢神经系统症状可能提示PRES。
