Department of Neurology, Affiliated Hospital of Qingdao University, Shandong, China.
J Oncol Pharm Pract. 2023 Sep;29(6):1503-1509. doi: 10.1177/10781552231177597. Epub 2023 May 22.
Posterior reversible encephalopathy syndrome is a clinical and imaging syndrome characterized by endothelial dysfunction, blood-brain barrier disruption, and vasogenic edema. The common clinical symptoms of posterior reversible encephalopathy syndrome include headache, altered consciousness, visual disturbances, and seizures, among which headache and seizures are the most common. The classic imaging patterns usually reveal vasogenic edema.
We describe the case of a middle-aged woman with gastric cancer. She was under treatment by fluorouracil, leucovorin, oxaliplatin, and docetaxel regimen and thrombocytopenia regimen after tumor progression, but developed unconsciousness, irritability, and headache shortly after initiation of treatment. Her magnetic resonance imaging in our hospital shows abnormal signals in bilateral frontal parietal occipital lobes with hyperintensities on T2-weighted magnetic resonance imaging and fluid-attenuated inversion recovery imaging, accompanied by the increased value of apparent diffusion coefficient. And T1-weighted images illustrate hypointense foci, with increased diffusion-weighted imaging signals.
After admission, she was treated to control blood pressure, reduce brain edema, expand blood vessels, improve consciousness, and symptomatic support treatment. 3 days after the onset of the disease, her headache symptoms and state of consciousness gradually improved, and her blood pressure can be controlled at about 130/80 mmHg.
This is the first report that posterior reversible encephalopathy syndrome is caused by a thrombocytopenia regimen, and our case highlights the pathogenic role of a thrombocytopenia regimen in posterior reversible encephalopathy syndrome. However, the association between the thrombocytopenia regimen and previous fluorouracil, leucovorin, oxaliplatin, and docetaxel regimens needs further study.
后部可逆性脑病综合征是一种以血管内皮功能障碍、血脑屏障破坏和血管源性水肿为特征的临床和影像综合征。后部可逆性脑病综合征的常见临床症状包括头痛、意识改变、视觉障碍和癫痫发作，其中头痛和癫痫发作最为常见。经典的影像学模式通常显示血管源性水肿。
我们描述了一例中年女性胃癌患者的病例。她在肿瘤进展后接受氟尿嘧啶、亚叶酸钙、奥沙利铂和多西他赛方案以及血小板减少症方案治疗，但在开始治疗后不久出现了意识不清、烦躁和头痛。我院磁共振成像显示双侧额顶枕叶异常信号，T2 加权磁共振成像和液体衰减反转恢复成像呈高信号，表观弥散系数增加。T1 加权图像显示低信号病灶，扩散加权成像信号增加。
入院后，给予控制血压、减轻脑水肿、扩张血管、改善意识和对症支持治疗。发病后 3 天，头痛症状和意识状态逐渐改善，血压可控制在约 130/80mmHg。
这是首例报道血小板减少症方案引起的后部可逆性脑病综合征，我们的病例强调了血小板减少症方案在后发性可逆性脑病综合征中的致病作用。然而，血小板减少症方案与先前的氟尿嘧啶、亚叶酸钙、奥沙利铂和多西他赛方案之间的关联需要进一步研究。
