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PRES in the course of hemato-oncological treatment in children
Katarzyna Musioł1, Sylwia Waz2, Michał Boroń2
1Department of Pediatric Oncology, Hematology and Chemotherapy, Medical University of Silesia, Upper Silesia Children's Care Health Centre, 16 Medykow Str, 40-752, Katowice, Poland. katkamusiol@gmail.com.
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Posterior reversible encephalopathy syndrome (PRES) can occur during pediatric cancer treatment. Hypertension is a key risk factor, and PRES symptoms often resolve with treatment, but it should be considered in neurological cases.
Area of Science:
- Neurology
- Pediatric Oncology
- Radiology
Background:
- Posterior reversible encephalopathy syndrome (PRES) is a neurological condition characterized by acute brain dysfunction and MRI abnormalities.
- PRES typically presents with neurological symptoms and resolves without lasting consequences, but can have varied etiologies.
Purpose of the Study:
- To analyze predisposing factors, clinical outcomes, and radiological features of PRES in pediatric hemato-oncological patients.
- To understand the specific presentation and course of PRES in children undergoing cancer treatment.
Main Methods:
- Retrospective analysis of medical records of eight pediatric patients with hemato-oncological diseases and PRES.
- Review of clinical presentations, treatment regimens, hypertension history, electrolyte balance, and MRI findings.
Main Results:
- Seven of eight patients received intensive chemotherapy; PRES occurred between 6 and 556 days post-treatment initiation.
- Hypertension (in 6/8) and hypomagnesemia (in 2/8) were significant predisposing factors.
- Common symptoms included headache, altered consciousness, seizures, and visual disturbances; MRI showed typical posterior white matter edema, which resolved within weeks.
Conclusions:
- PRES is a potential complication of pediatric oncological treatment.
- Hypertension is identified as the most critical risk factor for PRES in this population.
- PRES should be considered in the differential diagnosis of acute neurological symptoms in children undergoing cancer therapy.
Introduction:
Posterior reversible leukoencephalopathy syndrome (PRES) is a clinical syndrome of varying aetiologies, characterised by acute neurological symptoms of brain dysfunction with MRI abnormalities in posterior cerebral white and grey matter. In most cases, symptoms resolve without neurological consequences.
Aim:
The aim of this paper is the analysis of predisposing factors, clinical outcomes and radiological features of PRES in eight children with hemato-oncological disease.
Material And Methods:
We analysed the medical records of eight hemato-oncological patients aged from 3.0 to 16.1 years. The mean of age at primary diagnosis was 8.5 years.
Results:
All patients had both clinical and radiological PRES features. Seven out of eight underwent intensive chemotherapy regimens. Time elapsed from start of treatment to the occurrence of PRES ranged from 6 to 556 days. In one case, PRES occurred before chemotherapy and was the first symptom of cancer. Most (six of eight) patients had history of hypertension (> 95pc) and some (two of eight) occurred electrolyte imbalance-mainly hypomagnesaemia. Patients presented headache (seven of eight), disturbances of consciousness (six of eight), seizures (six of eight), visual changes (four of eight) and vomiting (three of eight). MRI demonstrated abnormalities in seven children: typical cerebral oedema in the white matter of the occipital to the parietal lobes. Most patient lesions in the MRI shrunk after 4 weeks, and clinical symptoms of PRES disappeared completely within a few hours to few days.
Conclusion:
PRES may complicate oncological treatment in children. Hypertension is the most important risk factor of PRES. PRES should be included in differential diagnosis in all patients with acute neurological symptoms.
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