Современная онкология (Jan 2017)
Posterior reversible encephalopathy syndrome in children with hematological and oncology diseases
Abstract
Subject. Posterior reversible encephalopathy syndrome (PRES) is often a complication in the treatment of hematological and malignancy diseases, in the post-transplant period in children. Objective. Describe the clinical, magnetic resonance imaging (MRI) and electroencephalography (EEG) changes in children with PRES. Materials and methods. We observed 7 patients with PRES aged 5-22 years (2 of them girls) with hematologic and malignancies diseases. Results. PRES developed because of hypertension in 6 patients, during immunosuppressive therapy (cyclosporine and methotrexate). 3 patients had generalized seizures. We observed in 1 child hyperkinesis of oral musculature, eye deviation, impaired consciousness. Development of hypertensive syndrome, altered mental status, visual disturbances were observed in 3 patients, 2 of them combined with a headache. Repeated signs of PRES were observed in 2 children, one of these as tonic-clonic seizures. According to the MRI changes were observed in patients of white matter of the brain predominantly parietal-occipital regions. EEG during debut PRES were recorded expressed diffuse changes in brain activity in the background recording marked disorganization brain activity slow waves and persistent hemispheric asymmetry. Local changes epileptic nature recorded in 1 child in the form of slow waves emphasis in the central parietal regions of the left with the inclusion of acute a-waves and single generalized paroxysm, the 2-nd - in the form of single epileptic complexes “sharp-slow wave” in the fronto-central department right, in the 3-rd - as a hotbed of epileptic activity in the fronto-temporal department left a sharp wave complexes and “sharp-slow wave”. These local changes in EEG corresponded described MRI picture of these children. PRES outcome was epilepsy in 2 patients, 3 children clinical-radiological symptoms were reversible. Underlying disease was fatal to 3 children. Conclusions. For the diagnosis of PRES and its outcome is paramount early clinical-radiological diagnosis with MRI registration, including the registration of EEG.
