Posterior reversible encephalopathy syndrome in children with cancer
Posterior reversible encephalopathy syndrome in children with cancer
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DOI：
10.1002/pbc.20703
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发表时间：
2007-02-01
影响因子：
3.2
通讯作者：
Khan, Raja B.
中科院分区：
文献类型：
--
作者：
Morris, E. Brannon;Laningham, Fred H.;Khan, Raja B.
目的.确定接受癌症治疗的儿童后部可逆性白质脑病（PRES）的诱发因素、影像学特征和临床结局。方法.我们确定了11例患者（7名女性），他们的放射学和临床特征与PRES一致，并于1995年1月至2005年1月在圣裘德儿童研究医院接受癌症治疗。从他们的记录中提取临床和影像学数据。结果PRES发作时的平均年龄为10.4岁。初步诊断为急性白血病（n = 8）、非霍奇金淋巴瘤（n = 2）和尤文肉瘤（n = 1）。8例患者在治疗诱导期发生PRES，所有11例患者均患有高血压（5例为慢性）。3例患者的癫痫发作活动与阿糖胞苷和他克莫司给药接近，2例患者再次给予这些药物后发生进一步癫痫发作。凝血和化学检查正常。同时进行的脑部磁共振成像（MRI）显示所有11例患者的T2信号异常，4例弥散受限，3例出血。随访MRI显示3例患者的慢性变化与既往出血一致，1例患者有既往脑实质缺血证据。3名患者出现癫痫，仍在接受长期抗惊厥治疗。结论. PRES是儿科癌症治疗中越来越被认识到的并发症。儿科癌症患者PRES的危险因素包括高血压（不一定是急性）、缓解诱导化疗和他克莫司给药。磁共振图像常表现为不典型的表现，其中一些是不可逆的。尽管有临床和影像学证据表明癫痫已恢复，但仍有相当数量的患者发生癫痫。
Purpose. To identify predisposing factors, radiologic features, and clinical outcome of posterior reversible leucoencephalopathy (PRES) in children receiving cancer treatment. Methods. We identified 11 patients (7 female) who had radiological and clinical features consistent with PRES and were treated for cancer at St. Jude Children's Research Hospital between January 1995 and January 2005. Clinical and radiographic data were abstracted from their records. Results. The average age at the time of PRES onset was 10.4 years. Primary diagnoses were acute leukemia (n = 8), non-Hodgkin lymphoma (n = 2), and Ewing sarcoma (n = 1). PRES occurred in 8 patients during the induction phase of treatment, and all 11 patients had hypertension (5 chronically). Seizure activity was proximate to cytarabine and tacrolimus administration in three patients and further seizures occurred with re-administration of these medications in two patients. Coagulation and chemistry studies were normal. Concurrent brain magnetic resonance imaging (MRI) demonstrated T2 signal abnormalities in all 11 patients, restricted diffusion in 4, and hemorrhage in 3. Follow-up MRI showed chronic changes consistent with a previous hemorrhage in three and evidence of prior parenchymal ischemia in one. Three patients developed epilepsy and remain on chronic anticonvulsant therapy. Conclusions. PRES is an increasingly recognized complication of pediatric cancer treatment. Risk factors for PRES in pediatric cancer patients include hypertension (not necessarily acute), remission induction chemotherapy, and administration of tacrolimus. MR images often show atypical findings, some of which are irreversible. A significant number of patients develop epilepsy despite clinical and radiographic evidence of recovery.