Gandini Jordi, Manto Mario, Charette Nicolas
Department of Neurology, CHU-Charleroi, Charleroi, Belgium.
Service des Neurosciences, University of Mons, Mons, Belgium.
Front Neurol. 2020 Jan 30;10:1405. doi: 10.3389/fneur.2019.01405. eCollection 2019.
Posterior reversible encephalopathy syndrome (PRES) is a potentially severe disorder of the autoregulation of cerebral perfusion. The major clinical manifestations are headache, seizures, altered mental status, and visual loss. The typical radiological finding is vasogenic edema predominating in the white matter of occipital and parietal lobes. PRES is increasingly recognized as a clinico-radiological entity owing to improvements and fast availability of brain imaging, especially magnetic resonance imaging (MRI). We present the exceptional case of a 67-year-old female patient with a gastric adenocarcinoma at stage IIB (T3N0M0) treated by FLOT chemotherapy (5-fluorouracil, oxaliplatin, docetaxel, and folinic acid). Two months after the unique administration of FLOT regimen, she developed sudden posterior headache and visual loss. Blood pressure values were normal. Cerebral tomography showed ischemic-like occipital bilateral lesions, and angiographic sequences revealed breakdown of the blood-brain barrier (BBB). MRI revealed bilateral parieto-occipital T1 hypointensity and T2 hyperintensity, which demonstrated vasogenic edema. The rest of the parts of the lesions were T1 hyperintensity, T2 hyperintensity, and diffusion-weighted imaging (DWI) hyperintensity, which indicate cortical laminar necrosis. After injection of gadolinium, a linear enhancement of the cortex was observed. She was treated with oral nimodipine. Follow-up was characterized by permanent visual sequelae and tetraparesis. PRES represents an urgent neurological condition. Our observation highlights that PRES should be considered in patients under chemotherapy, even when their blood pressure remains within normal range. This is the first report of PRES triggered by FLOT chemotherapy and with a silent window of 2 months between chemotherapy and PRES, widening further the spectrum of chemotherapy-induced PRES. Our case highlights the potential role of FLOT regimen in the pathogenesis of PRES and the need for a novel approach in terms of prevention of this potentially fatal complication when patients receive chemotherapy.
后部可逆性脑病综合征（PRES）是一种潜在的严重脑灌注自动调节障碍性疾病。主要临床表现为头痛、癫痫发作、精神状态改变和视力丧失。典型的影像学表现是枕叶和顶叶白质为主的血管源性水肿。由于脑成像技术的进步以及快速可得性，尤其是磁共振成像（MRI），PRES越来越被视为一种临床-影像学实体。我们报告了一例特殊病例，一名67岁女性患者，患有IIB期（T3N0M0）胃腺癌，接受了FLOT化疗（5-氟尿嘧啶、奥沙利铂、多西他赛和亚叶酸）。在独特的FLOT方案给药两个月后，她突然出现后部头痛和视力丧失。血压值正常。脑部断层扫描显示双侧枕叶类似缺血性病变，血管造影序列显示血脑屏障（BBB）破坏。MRI显示双侧顶枕叶T1低信号和T2高信号，提示血管源性水肿。病变的其余部分为T1高信号、T2高信号和扩散加权成像（DWI）高信号，提示皮质层状坏死。注射钆后，观察到皮质呈线性强化。她接受了口服尼莫地平治疗。随访显示存在永久性视力后遗症和四肢轻瘫。PRES是一种紧急的神经系统疾病。我们的观察强调，即使血压保持在正常范围内，接受化疗的患者也应考虑PRES。这是第一例由FLOT化疗引发的PRES报告，化疗与PRES之间有2个月的无症状期，进一步拓宽了化疗诱导的PRES的范围。我们的病例突出了FLOT方案在PRES发病机制中的潜在作用，以及在患者接受化疗时预防这种潜在致命并发症方面需要一种新方法。
