Tseng Yu-Ju, Chen Chun-Nan, Hong Ruey-Long, Kung Woon-Man, Huang Abel Po-Hao
Department of Pharmacy, National Taiwan University Hospital, Taipei City 100, Taiwan.
Department of Otolaryngology, National Taiwan University Hospital, Taipei City 100, Taiwan.
Brain Sci. 2022 Dec 23;13(1):33. doi: 10.3390/brainsci13010033.
Posterior reversible encephalopathy syndrome (PRES) is a rare but severe neurological syndrome that may stem from the use of some medications. Although its mechanism is not well-known, hypertension and endothelial dysfunction have been mentioned in previous literature as being related. Lenvatinib serves as a neoplastic agent that inhibits the tyrosine kinase of vascular endothelial growth factor receptors (VEGFR). VEGFR inhibitors result in endothelial dysfunction and consequent hypertension by nitric oxide pathway suppression and endothelin (ET)-1 stimulation. We hypothesized that VEGFR inhibitors would cause PRES. Herein, we report the case of a 40-year-old man with olfactory neuroblastoma who developed PRES while undergoing treatment with lenvatinib, 7 months after initiation. The symptoms included loss of consciousness and seizures. Fortunately, the symptoms and presence of PRES in imaging resolved, 7 days and 1 month, respectively, after cessation of lenvatinib.
后部可逆性脑病综合征（PRES）是一种罕见但严重的神经综合征，可能源于某些药物的使用。尽管其发病机制尚不清楚，但既往文献中曾提及高血压和内皮功能障碍与之相关。乐伐替尼是一种抗肿瘤药物，可抑制血管内皮生长因子受体（VEGFR）的酪氨酸激酶。VEGFR抑制剂通过抑制一氧化氮途径和刺激内皮素（ET）-1导致内皮功能障碍，进而引发高血压。我们推测VEGFR抑制剂会导致PRES。在此，我们报告一例40岁嗅神经母细胞瘤男性患者，在开始使用乐伐替尼治疗7个月后出现PRES。症状包括意识丧失和癫痫发作。幸运的是，停用乐伐替尼后，症状分别在7天和1个月后消失，影像学上PRES也随之消退。
