Chemotherapy and Immunosuppressant Therapy-Induced Posterior Reversible Encephalopathy Syndrome

Area of Science:

• Neurology
• Radiology
• Pharmacology

Background:

• Posterior reversible encephalopathy syndrome (PRES) is a neurological disorder characterized by acute onset of symptoms including altered mental status, seizures, and headaches.
• Diagnosis relies on characteristic MRI findings, typically showing subcortical white matter involvement in the parieto-occipital lobes.

Purpose of the Study:

• To review the diverse etiologies and risk factors associated with PRES.
• To investigate the role of chemotherapeutic and immunosuppressant agents in causing PRES, including their mechanisms of action and side effect profiles.
• To compare the presentation and imaging findings of PRES induced by cytotoxic agents versus other causes.

Main Methods:

• Literature review of studies on Posterior Reversible Encephalopathy Syndrome (PRES).
• Analysis of drug-induced PRES, with a focus on cytotoxic and immunosuppressant agents.
• Comparison of clinical and radiological features across different PRES etiologies.

Main Results:

• Chemotherapeutic and immunosuppressant agents are significant contributors to PRES.
• PRES presentation and imaging may differ based on the causative agent.
• Management of drug-induced PRES is complex, especially when drug cessation poses risks like graft rejection.

Conclusions:

• Understanding drug-induced PRES, particularly from cytotoxic agents, is crucial for accurate diagnosis and management.
• The risk of graft rejection or graft-versus-host disease complicates the discontinuation of essential immunosuppressants in PRES patients.
• Further research is needed to optimize treatment strategies for PRES in the context of cytotoxic and immunosuppressant therapies.