Cancer Res Treat.  2009 Mar;41(1):53-55.

A Case of Gemcitabine and Cisplatin Associated Posterior Reversible Encephalopathy Syndrome

Affiliations
  • 1Department of Internal Medicine, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Goyang, Korea. smdkdy@hanmail.net
  • 2Department of Neurology, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Goyang, Korea.
  • 3Department of Radiology, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Goyang, Korea.

Abstract

A 58-year-old female receiving gemcitabine and cisplatin chemotherapy for stage IV gallbladder cancer developed the clinicoradiologic syndrome, posterior reversible encephalopathy syndrome (PRES). Just before the 4th gemcitabine chemotherapy cycle, she was admitted to the hospital with complaints of headache, dizziness, and generalized tonic-clonic seizures. A MRI was performed on the day when the seizure developed, and the findings showed patchy cortical and subcortical T2 hyperintensity without enhancement that involved both occipital and parietal lobes. Phenytoin loading and maintenance was started for prevention of recurrent seizures, which was successful. The follow-up brain MRI obtained 10 days after the seizure attack showed completely resolved radiologic findings. After the MRI findings revealed complete resolution, phenytoin maintenance was stopped. Even with discontinuation of phenytoin, she had no seizures or other clinical manifestations.

Keyword

Cisplatin; Gemcitabine; Posterior reversible encephalopathy syndrome (PRES)

MeSH Terms

Brain
Cisplatin
Deoxycytidine
Dizziness
Female
Follow-Up Studies
Gallbladder Neoplasms
Headache
Humans
Middle Aged
Parietal Lobe
Phenytoin
Seizures
Cisplatin
Deoxycytidine
Phenytoin

Figure

  • Fig. 1 Patchy cortical and subcortical T2 hyperintensity without enhancement, bilateral occipital and parietal lobes (on the day of seizure attack [7/31/2008]).

  • Fig. 2 Improved state of patchy cortical and subcortical T2 hyperintensity without enhancement since 7/31/2008, bilateral occipital and parietal lobes (10 days after seizure attack [8/11/2008]). (on the day of seizure attack [7/31/2008]).


Reference

1. Hinchey J, Chaves C, Appignani B, Breen J, Pao L, Wang A, et al. A reversible posterior leukoencephalopathy syndrome. N Engl J Med. 1996; 334:494–500. PMID: 8559202.
Article
2. Rangi PS, Partridge WJ, Newlands ES, Waldman AD. Posterior reversible encephalopathy syndrome: A possible late interaction between cytotoxic agents and general anesthesia. Neuroradiology. 2005; 47:586–590. PMID: 15997391.
3. Irvin W, MacDonald G, Smith JK, Kim WY. Dexamethasone-induced posterior reversible syndrome. J Clin Oncol. 2007; 25:2484–2486. PMID: 17557962.
4. Beck WT, Kuttesch JF. Neurological symptoms associated with cyclosporin plus doxorubicin. Lancet. 1992; 340:496. PMID: 1354830.
Article
5. Ito Y, Arahata Y, Goto Y, Hirayama M, Nagamutsu M, Yasuda T, et al. Cisplatin neurotoxicity presenting as reversible posterior leukoencephalopathy syndrome. AJNR Am J Neuroradiol. 1998; 19:415–417. PMID: 9541291.
6. Baker WJ, Royer GL Jr, Weiss RB. Cytarabine and neurologic toxicity. J Clin Oncol. 1991; 9:679–693. PMID: 1648599.
Article
7. Russell MT, Nassif AS, Cacayorin ED, Awwad E, Perman W, Dunphy F. Gemcitabine-associated posterior reversible encephalopathy syndrome: MR imaging and MR spectroscopy findings. Magn Reson Imaging. 2001; 19:129–132. PMID: 11295355.
Article
8. Rajasekhar A, George TJ Jr. Gemcitabine-induced reversible posterior leukoencephalopathy syndrome: A case report and review of literature. Oncologist. 2007; 12:1332–1335. PMID: 18055853.
9. Cho SG, Moon H, Lee JH, Lee SY, Kim CC, Lee KS. Behenoyl cytarabine-associated reversible encephalopathy in a patient with acute myelogenous leukemia. J Korean Med Sci. 1999; 14:89–92. PMID: 10102531.
Article
10. Choi SM, Lee SH, Yang YS, Kim BC, Kim MK, Cho KH. 5-Fluorouracil-induced leukoencephalopathy in patients with breast cancer. J Korean Med Sci. 2001; 16:328–334. PMID: 11410695.
Article
11. Kim GH, Cho TH, Park JY, Chung YG, Lee KC, Lee HK. Leukoencephalopathy Associated with 5-Fluorouracil and Cisplatin Therapy. J Korean Neurosurg Soc. 1996; 25:622–626.
12. Port JD, Beauchamp NJ Jr. Reversible intracerebral pathologic entities mediated by vascular autoregulatory dysfunction. Radiographics. 1998; 18:353–367. PMID: 9536483.
Article
13. Lee EJ, Song CJ, Yu WJ, Ahn KJ, Jung SL, Lee YS, et al. Reversible Posterior Leukoencephalopathy Syndrome. J Korean Radiol Soc. 2001; 45:339–346.
Article
14. Larsen FO, Hansen SW. Severe neurotoxicity caused by gemcitabine treatment. Acta Oncol. 2004; 43:590–591. PMID: 15370618.
Article
15. Govindarajan R, Adusumilli J, Baxter DL, El-Khoueiry A, Harik SI. Reversible posterior leukoencephalopathy syndrome induced by RAF kinase inhibitor BAY 43-9006. J Clin Oncol. 2006; 24:e48. PMID: 17008686.
Article
Full Text Links
  • CRT
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr