A rare cause of posterior reversible encephalopathy syndrome: Acute lymphoblastic leukemia
Jessica Hayes1, Anne Byrd Mahoney1,2, Claci Ayers1,3
1Department of Pediatrics, Vanderbilt University Medical Center Monroe Carell Jr. Children's Hospital Nashville Tennessee USA.
Insights
Posterior reversible encephalopathy syndrome (PRES) rarely presents as the first sign of acute lymphoblastic leukemia (ALL). This case emphasizes considering leukemia in children with new-onset hypertension and PRES.
Area of Science:
- Pediatric Neurology
- Pediatric Hematology-Oncology
- Nephrology
Background:
- Posterior reversible encephalopathy syndrome (PRES) is a neurological condition characterized by headache, seizures, altered consciousness, and visual disturbances.
- PRES is typically associated with conditions like severe hypertension, renal disease, autoimmune disorders, and certain medications.
- While PRES can be a complication of chemotherapy, its presentation as an initial symptom of acute lymphoblastic leukemia (ALL) is uncommon.
Key Clinical Message:
The presentation of posterior reversible encephalopathy syndrome (PRES) as the initial presenting sign of acute lymphoblastic leukemia is unusual, as PRES is more often a complication of therapy. This case highlights the importance of maintaining a broad differential diagnosis for pediatric hypertension and its complications.
Abstract:
A 6-year-old male presented with a seizure-like episode. Evaluation revealed hypertension and brain imaging showed findings consistent with posterior reversible encephalopathy syndrome. Complete blood count showed lymphoblasts, and the cause of his hypertension was determined to be renal infiltration of leukemia cells due to B-cell acute lymphoblastic leukemia.
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