A Pressing Emergency in Oncology: A Case Series of Patients With Posterior Reversible Encephalopathy Syndrome.

Background: The defining characteristic of posterior reversible encephalopathy syndrome (PRES) is a reversible, predominantly vasogenic edema of the white matter, particularly affecting the parenchyma supplied by the posterior circulation. PRES is most commonly associated with hypertension. We present a case series of seven normotensive patients diagnosed with cancer who had posterior reversible encephalopathy syndrome.
Materials and Methods: This series of retrospective cases includes seven patients hospitalized between August 2022 and October 2024, all with a primary oncological condition and diagnosed with PRES either at admission or during their hospital stay. PRES was established according to the diagnostic criteria outlined in the 2012 Berlin Study. Our study concentrated on clinical characteristics, including underlying disease, triggering clinical events, chemotherapy agents, and outcome measures such as reversibility, functional status, and mortality.
Results: The median age of patients in this study was 48 years. No patient exhibited significantly elevated blood pressure during their inpatient stay. Altered consciousness with seizures was the primary initial manifestation in most patients, followed by headache. The predominant observation on the MRI was T2 flair hyperintensity in the posterior circulation. All subjects attained nearly full neurological recovery by 28 days, regardless of steroid therapy. The 90-day all-cause mortality rate was 14% (one out of seven patients). There were no fatalities attributable to PRES.
Conclusion: Posterior reversible encephalopathy syndrome is a neurological emergency that may evade the discerning attention of the attending physician. Owing to the extensive range of clinical features and MRI findings, the list of differential diagnoses is substantial. The reversibility of symptoms, while not always applicable, is predominantly certain, as demonstrated in our case series. We must extend our focus beyond conventional risk variables such as hypertension to consider additional clinical insults. Delayed diagnosis may lead to worse neurological outcomes.
Competing Interests: Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Vydehi Institutional Ethics Committee issued approval VIEC/2024/APP/83. This is to certify that the case series titled "A Pressing Emergency in Oncology: A Case Series of Patients With Posterior Reversible Encephalopathy Syndrome, "submitted by Dr. Vikram L., Assistant Professor, Department of Critical Care, Vydehi Institute of Medical Sciences and Research Centre, is approved by the Vydehi Institutional Ethics Committee. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.
(Copyright © 2024, Narasimhan et al.)