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Posterior reversible encephalopathy syndrome in paediatric leukaemia
Bianca Panis1, Annemarie M M Vlaar, Gijs Th J van Well
1Department of Paediatrics, Maastricht University Medical Center, Maastricht, The Netherlands. bianca.panis@mumc.nl
Insights
Posterior reversible encephalopathy syndrome (PRES) can occur in children with acute lymphoblastic leukaemia during induction treatment. Prompt management of hypertension is key, as PRES is often reversible.
Area of Science:
- Neurology
- Pediatric Oncology
- Hematology
Background:
- Acute lymphoblastic leukaemia (ALL) treatment involves intensive induction chemotherapy.
- Posterior Reversible Encephalopathy Syndrome (PRES) is a neurological condition.
- The link between pediatric ALL induction and PRES requires further investigation.
Observation:
- Four pediatric patients with ALL developed PRES during induction therapy.
- All patients were treated with a new induction protocol.
- Neurological symptoms were observed in the context of ALL treatment.
Findings:
- Hypertension appears to be a significant factor in PRES development, potentially secondary.
- PRES in this context was frequently associated with the new ALL induction protocol.
- The exact multifactorial mechanism of PRES remains unclear.
Implications:
- Considering PRES in pediatric ALL patients with neurological symptoms during induction is crucial.
- Investigating the incidence of PRES within ALL induction schemes is necessary.
- Optimizing ALL treatment protocols may involve managing PRES-associated factors like hypertension.
Abstract:
This report describes four patients with acute lymphoblastic leukaemia, suffering from posterior reversible encephalopathy syndrome during the induction period of treatment. A review of the literature on posterior reversible encephalopathy syndrome in paediatric leukaemia is given. The exact mechanism of posterior reversible encephalopathy syndrome is not clear and seems to be multifactorial. Hypertension is likely to play a major role in the development but could be also secondary. All patients in this case series presented after introduction of the new induction protocol for acute lymphoblastic leukaemia. Treatment of hypertension is likely to have a favourable role and posterior reversible encephalopathy syndrome is most often reversible. It is important to consider this diagnosis during the induction phase of leukaemia treatment in the presence of neurological symptoms. The incidence of PRES in the induction scheme should be investigated, in order to optimize the ALL treatment.
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