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1.
Medicine (Baltimore) ; 98(46): e17787, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31725620

RESUMO

RATIONALE: Reversible posterior leukoencephalopathy syndrome (RPLS) is characterized by rapidly progressive hypertension, headache, and disturbance of consciousness. Moreover, RPLS is rarely reported after apatinib treatment. PATIENT CONCERNS: We present a case of RPLS induced by apatinib in this report. The patient had dizziness and bilateral lower limb weakness after apatinib use for 12 days. DIAGNOSIS AND INTERVENTIONS: Cranial T2-weighted magnetic resonance imaging (MRI) revealed symmetrical increased signal intensity in bilateral areas of the basal ganglia, radiation crown, frontal lobe, parietal lobe, and occipital lobe, which was suggestive of RPLS. The patient discontinued apatinib use and was administered dexamethasone, mannitol, and antihypertensive drugs. OUTCOMES: The patient's blood pressure returned to normal and neurological symptoms improved after 3 days of discontinuation of apatinib use. Moreover, brain MRI showed complete resolution of previous changes after 44 days of discontinuation of apatinib use. LESSONS: Increased blood pressure may damage the normal blood-brain barrier, resulting in the extravasation of the fluid into the brain parenchyma. Hypertension is a significant cause of RPLS. It is important to strictly monitor blood pressure during apatinib treatment.


Assuntos
Síndrome da Leucoencefalopatia Posterior/induzido quimicamente , Piridinas/efeitos adversos , Neoplasias Gástricas/tratamento farmacológico , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Síndrome da Leucoencefalopatia Posterior/diagnóstico por imagem , Piridinas/uso terapêutico
4.
Artigo em Inglês | MEDLINE | ID: mdl-31152638

RESUMO

Posterior reversible encephalopathy syndrome (PRES) is one of the most serious complication after allogeneic stem cell transplantation in paediatric setting. It is most commonly reported as adverse event of immunosuppressive strategies during transplantation. We present a case of a 7 years old girl with myelodysplastic syndrome (MDS) treated with allogeneic stem cell transplantation (ASCT) at our department. Diagnosis of PRES was confirmed by imaging techniques during the first month after transplant and it was very likely connected with cyclosporine neurotoxicity. The aim of this article is to present our first experience in diagnosing and treating PRES in paediatric stem cell transplantation. Our experience showed that PRES is one of the reasons for higher transplant related mortality in children. Early prediction of factors contributing to PRES and closely monitoring of patient's vital signs, especially blood pressure, neurological status and vision are the main contributors for challenging the patient with another immunosuppressive agent that has less neurological toxicity. Still studies have to be initiated to confirm the influence of PRES on transplant outcome.


Assuntos
Ciclosporina/efeitos adversos , Imunossupressores/efeitos adversos , Síndromes Mielodisplásicas/terapia , Síndrome da Leucoencefalopatia Posterior/induzido quimicamente , Criança , Ciclosporina/uso terapêutico , Evolução Fatal , Feminino , Doença Enxerto-Hospedeiro/tratamento farmacológico , Humanos , Síndromes Neurotóxicas/diagnóstico por imagem , Síndrome da Leucoencefalopatia Posterior/diagnóstico por imagem , Síndrome da Leucoencefalopatia Posterior/tratamento farmacológico , Transplante de Células-Tronco/métodos , Transplante Homólogo/métodos
5.
Rev. neurol. (Ed. impr.) ; 68(10): 426-430, 16 mayo, 2019. tab, ilus
Artigo em Espanhol | IBECS | ID: ibc-180738

RESUMO

Introducción. La relevancia del fármaco inmunosupresor tacrolimús en la prevención del rechazo y la enfermedad de injerto contra huésped en pacientes trasplantados es indiscutible. Sin embargo, con frecuencia, el tacrolimús presenta efectos neurotóxicos, incluyendo cuadros graves, como el síndrome de leucoencefalopatía posterior reversible. Caso clínico. Varón de 75 años, con antecedentes de trasplante renal hace cinco años, en tratamiento con tacrolimús y micofenolato, y de enfermedad de Parkinson avanzada, en tratamiento con varios agonistas dopaminérgicos. Acudió a urgencias por un cuadro de una semana de evolución consistente en alucinaciones visuales, delirios, ánimo expansivo, confusión y cefalea. La exploración psicogeriátrica por focos mostró como primera opción diagnóstica una psicosis secundaria a agonistas dopaminérgicos, sin excluir otras causas yatrógenas a pesar de encontrarse el tacrolimús en el rango terapéutico (8,3 ng/mL). Se realizaron una tomografía computarizada craneal, que no mostró hallazgos significativos, y una resonancia magnética, en la que se visualizó un edema parietooccipital bilateral, hallazgo compatible con un síndrome de leucoencefalopatía posterior reversible. Durante el ingreso se sustituyó el tacrolimús por everolimús y se ajustó la medicación dopaminérgica, con lo que se produjo de forma rápida una remisión completa del cuadro. Conclusiones. El diagnóstico de síndrome de leucoencefalopatía posterior reversible debe considerarse en los pacientes con antecedentes de trasplante de órgano en tratamiento con fármacos inmunosupresores que presentan un cuadro de instauración aguda con síntomas neurológicos o psiquiátricos


Introduction. The relevance of the immunosuppressive drug tacrolimus in the prevention of rejection and graft-versushost disease in transplanted patients is beyond all doubt. However, tacrolimus often has neurotoxic effects, including severe conditions such as posterior reversible leukoencephalopathy syndrome. Case report. A 75-year-old male who had undergone a kidney transplantation five years earlier, for which he was receiving treatment with tacrolimus and mycophenolate. He also had advanced Parkinson’s disease, treated with several dopamine agonists. The patient visited the emergency department after a week-long history of visual hallucinations, delirium, expansive mood, confusion and headache. The focal psychogeriatric examination revealed psychosis secondary to dopaminergic agonists as the first diagnostic option, without excluding other possible iatrogenic causes despite the tacrolimus being within the therapeutic range (8.3 ng/mL). Both cranial computed tomography, which did not show any significant findings, and a magnetic resonance scan, in which a bilateral parietooccipital oedema was observed, were performed, this latter finding being compatible with posterior reversible leukoencephalopathy syndrome. While the patient was in hospital, tacrolimus was replaced by everolimus, and the dopaminergic medication was adjusted, resulting in a swift and full remission of the clinical signs and symptoms. Conclusions. The diagnosis of posterior reversible leukoencephalopathy syndrome should be considered in patients with a history of organ transplantation treated with immunosuppressive drugs who have an acute onset condition with neurological or psychiatric symptoms


Assuntos
Humanos , Masculino , Idoso , Tacrolimo/efeitos adversos , Imunossupressores/efeitos adversos , Síndrome da Leucoencefalopatia Posterior/induzido quimicamente , Síndrome da Leucoencefalopatia Posterior/diagnóstico , Tacrolimo/uso terapêutico , Imunossupressores/uso terapêutico , Transplante de Rim , Rejeição de Enxerto/tratamento farmacológico
7.
BMJ Case Rep ; 12(2)2019 Feb 11.
Artigo em Inglês | MEDLINE | ID: mdl-30755423

RESUMO

Posterior reversible encephalopathy syndrome (PRES) is a clinico-radiological entity described by Hinchey et al in late 90's, characterised by variable associations of seizure activity, consciousness impairment ranging from confusion to coma, headaches, visual abnormalities, nausea/vomiting and focal neurological signs. Common causes are accelerated hypertension, eclampsia, preeclampsia, cytotoxic drug use and autoimmune diseases like systemic lupus erythematosus.We report a case of PRES in a 62-year-old female patient due to hypercalcemia secondary to vitamin D toxicity on treatment with calcium supplements and vitamin D for secondary hypoparathyroidism. She had seizures and visual defects on presentation which recovered completely with treatment of hypercalcemia.


Assuntos
Cálcio na Dieta/efeitos adversos , Hipercalcemia/complicações , Hipercalcemia/diagnóstico , Hipoparatireoidismo/tratamento farmacológico , Síndrome da Leucoencefalopatia Posterior/induzido quimicamente , Síndrome da Leucoencefalopatia Posterior/diagnóstico , Vitamina D/efeitos adversos , Anlodipino/uso terapêutico , Cálcio na Dieta/administração & dosagem , Suplementos Nutricionais , Feminino , Hidratação , Humanos , Pessoa de Meia-Idade , Síndrome da Leucoencefalopatia Posterior/terapia , Convulsões/induzido quimicamente , Resultado do Tratamento , Transtornos da Visão/induzido quimicamente , Vitamina D/administração & dosagem
8.
J Oncol Pharm Pract ; 25(8): 2019-2022, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30537916

RESUMO

Posterior reversible encephalopathy syndrome has recently been recognized as an entity characterized by central neurological and radiological manifestations. There are increasing reports of posterior reversible encephalopathy syndrome associated with the use of chemotherapeutic agents. We herein present a case of posterior reversible encephalopathy syndrome occurring in a patient with Hodgkin's lymphoma after taking two courses of adriamycin, bleomycin, vinblastine, dacarbazine chemotherapy. A prompt recognition of posterior reversible encephalopathy syndrome associated with vinblastine and discontinuation of this drug is paramount to prevent severe neurological damage.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Síndrome da Leucoencefalopatia Posterior/induzido quimicamente , Vimblastina/efeitos adversos , Adulto , Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Bleomicina/administração & dosagem , Dacarbazina/administração & dosagem , Doxorrubicina/administração & dosagem , Feminino , Doença de Hodgkin/tratamento farmacológico , Humanos , Vimblastina/administração & dosagem
10.
Tidsskr Nor Laegeforen ; 138(17)2018 10 30.
Artigo em Inglês, Norueguês | MEDLINE | ID: mdl-30378405

RESUMO

Posterior reversible encephalopathy syndrome (PRES) is a rare clinicoradiographic disorder characterized by acute neurological symptoms with typical neuroimaging findings of vasogenic edema in posterior regions of the brain. This complication is linked to a number of medical conditions, and is increasingly being documented as a side effect associated with a number of therapeutic agents. We present a case of PRES as a result of treatment with the vascular endothelial growth factor (VEGF) multikinase inhibitor, regorafenib. A man in his 50's with known metastatic colorectal cancer presented with headache, vomiting, altered mental state, reduced hand coordination and dexterity, and a homonymous inferior quadrantanopia. Symptoms developed soon after completion of the 3rd regorafenib therapy cycle. Cerebral MRI demonstrated signs indicative of PRES with bilateral vasogenic edema in the occipitotemporal regions. Regorafenib was subsequently discontinued and the patient's condition improved gradually, with normalization of his neurological symptoms within a month. Albeit rare, PRES has been linked to VEGF treatments, particularly sorafenib, sunitinib and pazopanib, however this is the second reported case linking regorafenib with PRES. PRES is usually associated with good prognosis. However, delayed diagnosis and treatment may lead to permanent neurological symptoms, higher morbidity and in rare cases mortality. Therefore increased awareness of this condition is vital.


Assuntos
Antineoplásicos/efeitos adversos , Compostos de Fenilureia/efeitos adversos , Síndrome da Leucoencefalopatia Posterior , Piridinas/efeitos adversos , Antineoplásicos/administração & dosagem , Antineoplásicos/uso terapêutico , Edema Encefálico/diagnóstico por imagem , Edema Encefálico/etiologia , Evolução Fatal , Humanos , Neoplasias Hepáticas/tratamento farmacológico , Neoplasias Hepáticas/secundário , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Compostos de Fenilureia/administração & dosagem , Compostos de Fenilureia/uso terapêutico , Síndrome da Leucoencefalopatia Posterior/induzido quimicamente , Síndrome da Leucoencefalopatia Posterior/complicações , Síndrome da Leucoencefalopatia Posterior/diagnóstico , Síndrome da Leucoencefalopatia Posterior/diagnóstico por imagem , Piridinas/administração & dosagem , Piridinas/uso terapêutico , Neoplasias Retais/patologia , Tomografia Computadorizada por Raios X
11.
Clin Neuropharmacol ; 41(6): 224-229, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30273191

RESUMO

Posterior reversible encephalopathy syndrome is a disorder of reversible subcortical vasogenic brain edema in the context of different diseases or exposure to cytotoxic drugs such as fludarabine. We present the case of a pediatric patient with ß-thalassemia who develops a fludarabine-induced posterior reversible encephalopathy while he received an induction regimen to achieve an allogenic hematopoietic cell transplantation. The clinical presentation consists in altered mental state, headache, status epilepticus, visual disturbance, and hypertension. His treatment was carried out with the suspension of the medication and the control of hypertension and status epilepticus; the final outcome was positive without additional complications. There are published reports about fludarabine toxicity in the central nervous system with different doses of the drug in different clinical context. We also made a review of the literature available and conclude that fludarabine is not an extraordinary cause of posterior reversible encephalopathy syndrome.


Assuntos
Síndrome da Leucoencefalopatia Posterior/induzido quimicamente , Vidarabina/análogos & derivados , Talassemia beta/tratamento farmacológico , Edema Encefálico/induzido quimicamente , Edema Encefálico/diagnóstico por imagem , Criança , Humanos , Masculino , Vidarabina/efeitos adversos , Vidarabina/uso terapêutico
12.
G Ital Nefrol ; 35(4)2018 Jul.
Artigo em Italiano | MEDLINE | ID: mdl-30035447

RESUMO

Small and medium vessel vasculitides, either ANCA-associated or caused by anti-GBM antibodies, are multisystemic diseases with predominantly renal involvement that often require dialysis support; clinical remission can be induced with immunosuppressive therapies including apheretic treatments, high doses of steroids, and immune suppressants. In addition to the complications resulting from the primary pathological process, those associated with the immunosuppressive therapies are not negligible. Reversible Posterior Encephalopathy Syndrome (PRES) is a clinical condition with a hyperacute onset, which can complicate the evolution of vasculitides while treated by immunosuppressive therapy. Relevant pathogenic factors are represented by alterations of the cerebral blood-brain barrier or vasogenic and/or brain edema phenomena, also related to uncontrolled hypertension. We describe two cases of patients with systemic vasculitides, rapidly progressive renal failure (RPGN) requiring dialysis, and poor response to the initial immunosuppressive therapy who were treated subsequently with rituximab. PRES developed immediately after administration of the drug, which, however resulted effective on the course of the vasculitis in one case and not effective in the other. In both cases, the subsequent radiological controls showed a total resolution of the encephalic alterations observed during the acute phase.


Assuntos
Fatores Imunológicos/efeitos adversos , Síndrome da Leucoencefalopatia Posterior/induzido quimicamente , Síndrome da Leucoencefalopatia Posterior/terapia , Diálise Renal , Rituximab/efeitos adversos , Idoso , Feminino , Humanos , Fatores Imunológicos/uso terapêutico , Masculino , Pessoa de Meia-Idade , Rituximab/farmacologia , Vasculite Sistêmica/tratamento farmacológico
13.
J Cancer Res Ther ; 14(3): 716-718, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29893350

RESUMO

Skin metastases, as a presenting symptom of gastrointestinal malignancies, are very rare and signify aggressive disease. They usually occur after a long period of diagnosis and along with other visceral metastases. We present the case of an 18-year-old male with diffuse subcutaneous metastases as a presenting feature and as the only site of distant metastases due to rectosigmoid adenocarcinoma. They clinically mimic benign skin lesions and the patient might not present to an oncologist. The diagnosis has to be established by skin biopsy, which will show tumor cell infiltration of the epidermis, dermis, and/or subcutaneous fat. There is no established local treatment for diffuse lesions. Systemic chemotherapy indicated for metastatic colon carcinoma was employed with not much favorable response. Irinotecan based chemotherapy also resulted in posterior reversible encephalopathy syndrome in this patient. Overall, the disease carries a poor prognosis and with no effective treatment available the survival is less than a year.


Assuntos
Adenocarcinoma/patologia , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Síndrome da Leucoencefalopatia Posterior/induzido quimicamente , Neoplasias Retais/patologia , Neoplasias do Colo Sigmoide/patologia , Neoplasias Cutâneas/secundário , Tela Subcutânea/patologia , Adenocarcinoma/tratamento farmacológico , Adolescente , Evolução Fatal , Humanos , Masculino , Neoplasias Retais/tratamento farmacológico , Neoplasias do Colo Sigmoide/tratamento farmacológico , Neoplasias Cutâneas/tratamento farmacológico , Tela Subcutânea/efeitos dos fármacos
16.
Curr Hypertens Rep ; 20(1): 8, 2018 02 24.
Artigo em Inglês | MEDLINE | ID: mdl-29478133

RESUMO

PURPOSE OF REVIEW: Acute drug-induced hypertension, sympathomimetic toxicity, and other hyperadrenergic states can be caused by both xenobiotic toxicity and withdrawal. This manuscript is a selective review of the recent literature regarding pharmacologic causes of hypertensive emergencies and other hyperadrenergic states. RECENT FINDINGS: We will discuss designer stimulants, alpha2 and baclofen agonist withdrawal, and the clinical entity known as posterior reversible encephalopathy syndrome (PRES). Additionally, we examine the controversial "unopposed alpha" phenomenon which may result from use of beta-adrenergic antagonist in the presence of stimulant toxicity. These topics encompass clinical situations and disease entities that are increasingly encountered and are often either unanticipated or under-recognized.


Assuntos
Hiperfunção Adrenocortical/induzido quimicamente , Hipertensão/induzido quimicamente , Síndrome de Abstinência a Substâncias/complicações , Simpatomiméticos/efeitos adversos , Hiperfunção Adrenocortical/etiologia , Doenças do Sistema Nervoso Autônomo/induzido quimicamente , Doenças do Sistema Nervoso Autônomo/etiologia , Humanos , Hipertensão/etiologia , Síndrome da Leucoencefalopatia Posterior/induzido quimicamente , Síndrome da Leucoencefalopatia Posterior/etiologia
17.
J Int Med Res ; 46(3): 1172-1177, 2018 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-29310486

RESUMO

An uncommon side effect of cyclosporine A (CsA) use is posterior reversible encephalopathy syndrome (PRES). PRES usually develops because of disturbed capacity of posterior cerebral blood flow to autoregulate an acute rise in blood pressure. We present the case of a 10-year-old girl who was previously diagnosed in our department with focal segmental glomerulosclerosis. She was treated with CsA and developed seizures, progressive loss of consciousness, and visual disturbance on the 7th day of treatment. Brain magnetic resonance imaging showed degeneration of white matter with diffuse demyelination in the parietal and posterior occipital lobes, consistent with the diagnosis of PRES. Cases of PRES reported in children are usually secondary to immunosuppressive therapy in oncological and haematological diseases. Our case is the fifth reported case of focal segmental glomerulosclerosis in children treated with CsA and complicated by PRES. Rapid recognition of PRES and stopping neurotoxic therapy early are essential for a good prognosis.


Assuntos
Ciclosporina/efeitos adversos , Glomerulosclerose Segmentar e Focal/tratamento farmacológico , Imunossupressores/efeitos adversos , Síndrome da Leucoencefalopatia Posterior/induzido quimicamente , Convulsões/induzido quimicamente , Criança , Feminino , Glomerulosclerose Segmentar e Focal/imunologia , Glomerulosclerose Segmentar e Focal/patologia , Humanos , Imagem por Ressonância Magnética , Lobo Occipital/diagnóstico por imagem , Lobo Occipital/efeitos dos fármacos , Lobo Occipital/patologia , Lobo Parietal/diagnóstico por imagem , Lobo Parietal/efeitos dos fármacos , Lobo Parietal/patologia , Síndrome da Leucoencefalopatia Posterior/diagnóstico por imagem , Síndrome da Leucoencefalopatia Posterior/imunologia , Síndrome da Leucoencefalopatia Posterior/patologia , Convulsões/diagnóstico por imagem , Convulsões/imunologia , Convulsões/patologia , Substância Branca/diagnóstico por imagem , Substância Branca/efeitos dos fármacos , Substância Branca/patologia
18.
J Pediatr Hematol Oncol ; 40(1): e13-e18, 2018 01.
Artigo em Inglês | MEDLINE | ID: mdl-29200159

RESUMO

Posterior reversible encephalopathy syndrome (PRES) in children with acute lymphoblastic leukemia has been increasingly recognized as a clinicoradiological entity. Our aim was to describe the incidence of PRES in pediatric patients with ALL, identify its risk factors, and examine its prognostic importance. For this research, we conducted a systematic, retrospective review of the patient records in a population-based series of children with acute lymphoblastic leukemia (n=643) treated in Finland from 1992 to 2008. Of the patients with ALL, 4.5% (n=29) developed radiologically confirmed PRES, of which 28 cases occurred during induction. Hypertension (P=0.006; odds ratio [OR], 4.10, confidence interval [CI], 1.50-11.25), constipation (P=0.001; OR, 5.60; CI, 2.02-15.52), and >14 days of alkalinization (P=0.017; OR, 3.27; CI, 1.23-8.68) were significant independent risk factors for PRES. One-third of the patients developed epilepsy. Relapses occurred significantly more often in those patients with PRES (P=0.001), which was associated with worse overall survival (P=0.040; 5-year survival=75.9% [60.3%-91.4%] vs. 88.4% [85.8%-90.9%]). Using NOPHO-ALL 92/2000 protocols, PRES is a significant early complication of therapy in ALL, and was associated with a poorer prognosis and significant neurological morbidity.


Assuntos
Síndrome da Leucoencefalopatia Posterior/induzido quimicamente , Leucemia-Linfoma Linfoblástico de Células Precursoras/complicações , Adolescente , Criança , Pré-Escolar , Epilepsia/etiologia , Feminino , Finlândia/epidemiologia , Humanos , Hipertensão/etiologia , Incidência , Quimioterapia de Indução/efeitos adversos , Lactente , Masculino , Síndrome da Leucoencefalopatia Posterior/epidemiologia , Síndrome da Leucoencefalopatia Posterior/etiologia , Leucemia-Linfoma Linfoblástico de Células Precursoras/tratamento farmacológico , Leucemia-Linfoma Linfoblástico de Células Precursoras/mortalidade , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Convulsões/etiologia , Análise de Sobrevida
19.
Invest New Drugs ; 36(2): 346-349, 2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-29067537

RESUMO

Posterior reversible encephalopathy syndrome (PRES) is a clinical entity characterized by acute neurological symptoms such as severe headache, seizures, and visual disturbance, and by typical reversible lesion on brain magnetic resonance (MR) images. Since PRES is thought to be caused by vascular endothelial injury due to cytotoxic agents or acute systemic hypertension, the number of reports on PRES associated with angiogenesis inhibitors has been increasing. Although five cases that developed PRES due to pazopanib for renal cell carcinoma have already been reported, none of PRES due to pazopanib for soft-tissue sarcoma has been reported thus far. We describe a case of a 49-year-old woman with retroperitoneal soft-tissue sarcoma who developed PRES during pazopanib administration. Pazopanib at 800 mg/day was administered as her third-line treatment at relapse. After 38 days of pazopanib, she was admitted to our hospital with severe headache, vomiting, and systemic hypertension. The next day, she developed consciousness deterioration and visual disturbance together with exacerbated systemic hypertension. Brain MR images revealed hyper-intense signals on FLAIR sequences in the bilateral occipital lobes and the left thalamus. Intravenous nicardipine injection was immediately started to control her blood pressure and pazopanib was discontinued. Her symptoms gradually improved and disappeared on the fifth hospital day. After 2 weeks, hyper-intense signals on a FLAIR sequence disappeared completely. She restarted a low dose of pazopanib under good blood pressure control and experienced no subsequent recurrence of PRES.


Assuntos
Síndrome da Leucoencefalopatia Posterior/induzido quimicamente , Inibidores de Proteínas Quinases/efeitos adversos , Inibidores de Proteínas Quinases/uso terapêutico , Pirimidinas/efeitos adversos , Pirimidinas/uso terapêutico , Sarcoma/tratamento farmacológico , Sulfonamidas/efeitos adversos , Sulfonamidas/uso terapêutico , Encéfalo/patologia , Evolução Fatal , Feminino , Humanos , Imagem por Ressonância Magnética , Pessoa de Meia-Idade , Síndrome da Leucoencefalopatia Posterior/diagnóstico por imagem , Sarcoma/diagnóstico por imagem
20.
Urol Int ; 100(3): 357-360, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-26845702

RESUMO

Posterior reversible encephalopathy syndrome (PRES) is a clinical and radiological syndrome characterized by acute hypertension, headache, decreased level of consciousness, visual disturbances and seizures associated with characteristic neuroimaging changes indicative of vasogenic edema of the posterior cerebral white matter. Several medical conditions have been associated with PRES including hypertensive encephalopathy and eclampsia. The use of cytotoxic and immunosuppressant drugs, such as those which target vascular endothelial growth factor (VEGF), have also been implicated. We report here the case of a 71-year-old woman with metastatic clear cell renal carcinoma who developed PRES 3 months after commencing sorafenib. Elevated blood pressure (BP) was recorded, and MRI of the brain) of the brain showed asymmetric areas of increased signal intensity within the supratentorial white matter suggestive of PRES. Clinical and radiological features rapidly improved with BP control and discontinuation of sorafenib. Sorafenib was resumed with no sign of PRES recurrence. The present case report supports the hypothesis that, in selected patients, the re-introduction of anti-VEGF therapies after PRES is feasible.


Assuntos
Carcinoma de Células Renais/complicações , Carcinoma de Células Renais/tratamento farmacológico , Imunossupressores/efeitos adversos , Neoplasias Renais/complicações , Neoplasias Renais/tratamento farmacológico , Síndrome da Leucoencefalopatia Posterior/induzido quimicamente , Sorafenibe/efeitos adversos , Idoso , Pressão Sanguínea , Encéfalo/diagnóstico por imagem , Feminino , Humanos , Hipertensão/patologia , Imunossupressores/uso terapêutico , Imagem por Ressonância Magnética , Metástase Neoplásica , Recidiva Local de Neoplasia , Sorafenibe/uso terapêutico , Trombose/patologia , Fator A de Crescimento do Endotélio Vascular/antagonistas & inibidores
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