Posterior reversible encephalopathy syndrome in children with malignances

According to the Delphi consensus of acute toxic effects of leukemia treatment, the diagnosis of posterior reversible encephalopathy syndrome (PRES) is based on transient neurological abnormalities (headache, seizures, visual disturbances, decreased consciousness) and typical MR-findings (vasogenic edema - common; restricted diffusion and hemorrhage – rare). Objectives: description of clinical cases of PRES in children with malignances and analysis of their causes and outcomes. Methods: We analyzed retrospectively clinical cases of PRES in 2 major Oncology Centers in Moscow during 3 years period. Laboratory and instrumental examination was performed for all patients with suspicion on PRES. Results: 13 cases of PRES in 11 children (2 repeated cases of PRES) were included (6 girls, 5 boys). The diagnoses of main disease were: 9/13 - acute lymphoblastic leukemia, 2/13 - Burkitt lymphoma, 2/13 – neuroblastoma. Median age was 9.25 years. Clinical presentation included seizures (11/13), dysphasia (2/13), visual disturbances (3/13), headache (3/13). Hyponatremia 3/11, hypocalcemia 2/11 patients (2/13 were no data). In 12/13 cases blood pressure (BP) was more than 95 percentile level (1/13 no BP data). Causes of PRES were regarded: 12/13 chemotherapy (methotrexate, vincristine etc), 1/13 cyclosporine A. 3/11 patients died (1 - resistant tumor, 2 – complications of therapy); 5/11 children are alive (1 girl with epilepsy); 3/11 – no data. Conclusion: It is important to control BP and neurological status during all period of treatment for management and prevention of PRES. Early prevention tactic (BP and pharmacokinetics monitoring) and rational therapeutic strategy are necessary to avoid irreversible brain damage