doi:10.1111/ejh.

12184 European Journal of Haematology 92 (90)

CLINICAL PICTURE

Posterior reversible encephalopathy syndrome during

induction chemotherapy for acute myeloid leukaemia

A 52-year-old man, treated for an acute myelo-monocytic A

leukaemia, presented on day 22 of the second induction
cycle an altered mental status with drowsiness, slurred
speech and an unstable gait without focal neurological signs.
A non-contrast cranial CT showed only non-specific findings,
whereas a 3-T MR showed bilateral occipital, mainly subcorti-
cal oedema on fluid attenuated inversion recovery (Fig. A) and
on T2-weighted (Fig. B) images, but with no restriction on
diffusion-weighted imaging (not shown). These findings are
compatible with a vasogenic oedema and allow the diagnosis
of posterior reversible encephalopathy syndrome (PRES).
A mild hypertension, noted 2 days before symptom onset,
was treated with amlodipine. Serum electrolytes were normal.
The mental alteration returned to normal within 2 days with-
out additional treatment. Fourteen days later, the MRI showed
complete resolution of the changes in the occipital region.
Posterior reversible encephalopathy syndrome is a condi-
tion characterized by changes in mental status, headache,
visual disturbances or other focal neurological deficiencies
and/or seizures together with symmetrical vasogenic oedema
in the posterior cerebral areas, initially described in the con-
text of severe hypertension. Loss of autoregulatory mecha-
nisms of the cerebral blood flow and endothelial damage are B
thought to be involved in the pathogenesis.
A variety of medical conditions were identified as potential
triggers including several chemotherapeutic agents, biological
therapies (monoclonal antibodies and small molecules) or
immunosuppressants. Fluid overload, a reduced renal function
and an increased blood pressure are further risk factors for
PRES during chemotherapy. Management includes correction
of hypertension, antiepileptic therapy for seizures and optimal
treatment of concomitant medical conditions as electrolyte dis-
turbances or infections.
Progression to cytotoxic oedema is a rare event, whereas
in most cases, PRES resolves completely with no residual
neurological deficiencies.

Tobias Silzle1, Nicola Glaser-Gallion2, Felicitas Hitz1

1
Department of Oncology/Haematology, Cantonal Hos-
pital, St. Gallen; 2Department of Radiology, Cantonal
Hospital, St. Gallen, Switzerland

Correspondence T. Silzle, Department of Oncology/

Haematology, Cantonal Hospital, Rorschacher Strasse
95 CH-9000 St. Gallen, Switzerland. Tel: +41 71 494 11
11; Fax: +41 71 494 63 25; e-mail: tobias.silzle@kssg.ch

90 © 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd