Posterior reversible encephalopathy syndrome in children with hematological diseases

Bronina NV, Shchederkina IO, Polushin AYu, et al. Posterior reversible encephalopathy syndrome in children with hematological diseases. S.S. Korsakov Journal of Neurology and Psychiatry. 2023;123(9‑2):33‑42. (In Russ.)
https://doi.org/10.17116/jnevro202312309233

Подписка 2026 Журнал неврологии и психиатрии им. С.С. Корсакова. Спецвыпуски (S.S. Korsakov Journal of Neurology and Psychiatry (special issues))

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OBJECTIVE

To assess risk factors (RF) and severity grade of Posterior reversible encephalopathy syndrome (PRES) in children with hematological diseases.

MATERIAL AND METHODS

We analyzed cases of PRES in children during chemotherapy (CT) and after allogeneic hematopoietic stem cell transplantation (allo-HSCT). We estimated the following RF: arterial hypertension, steroid therapy, CT, immunosuppressive therapy (IST), infection and renal injury.

RESULTS

Thirty-five cases of PRES occurred in 32 patients (8 after allo-HSCT and 27 during CT) were included in this study. In the most of cases (94.3%), there were 2 and more RF. An increase in blood pressure level (88.6%), CT and IST (82.8%) administration, steroid therapy (71.4%) were the most significant for PRES development. Infectious process and the decline in renal function played a lesser role in this syndrome (31.4% and 14%). At the initial presentation of PRES, there were seizures (94.3%), a decrease of consciousness (28.6%), headache, vision disturbances and stomachache (20%). In the most of cases (91.4%), the 2^nd and 3d grade according to the Common Terminology Criteria for Adverse Events (CTCAE 5.0) were observed. Brain magnetic resonance imaging (MRI) revealed the vasogenic edema of temporal (88.6%), occipital (74.3%), frontal (40%) lobes and the cerebellum (22.9%) more often than the cytotoxic edema (p=0.03). The cytotoxic edema was observed in the thalamus and the basal ganglia (2.9%) more often than in other parts of the brain (p<0.01).

CONCLUSION

The majority of PRES cases are caused by more than two RF. Arterial hypertension does not have a leading role among its causes. There is a significant correlation between the grade of PRES according to CTCAE 5.0 score and RF number (p<0.05).

Keywords:

posterior reversed encephalopathy syndrome

PRES

acute symptomatic seizures

chemotherapy

hematopoietic stem cell transplantation

Authors:

Bronina N.V.

Morozov Children’s City Clinical Hospital

ORCID: 0000-0003-2414-225X

Shchederkina I.O.

Morozov Children’s City Clinical Hospital;
Moscow Research and Clinical Centre for Neuropsychiatry

ORCID: 0000-0002-2302-1205

Polushin A.Yu.

Pavlov First State Medical University

ORCID: 0000-0001-8699-2482

Seliverstova E.V.

Morozov Children’s City Clinical Hospital

ORCID: 0000-0002-9528-3431

Skiba Y.B.

Pavlov First State Medical University

ORCID: 0000-0003-1955-1032

Kirgizov K.I.

Blokhin National Medical Research Center of Oncology

ORCID: 0000-0002-2945-284X

Bronin G.O.

Morozov Children’s City Clinical Hospital

ORCID: 0000-0002-0694-3996

Voznyuk I.A.

Pavlov First State Medical University

ORCID: 0000-0002-4292-4258

Received:

19.04.2023

Accepted:

02.06.2023

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