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Browsing by Subject "Posterior reversible encephalopathy syndrome (PRES)"
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Item Posterior Reversible Encephalopathy Syndrome: Incidence and Clinical Characteristics in Children with Cancer Katherine(Wolters Kluwer, 2022) Sommers, Katherine R.; Skiles, Jodi; Lelan, Brian; Rowan, Courtney M.; Pediatrics, School of MedicineThe etiology and outcomes of posterior reversible encephalopathy syndrome (PRES) in children with cancer are not well understood. We aim to determine the incidence of PRES, describe associated morbidity and mortality, and better understand risk factors in this patient population. 473 children with a hematologic malignancy or post-allogeneic hematopoietic cell transplantation (HCT) between June 2015 and June 2020 were screened for PRES to determine incidence and whether age or underlying diagnosis are associated with development of PRES. We conducted a case-control study to evaluate whether comorbidities or chemotherapeutic agents are associated with PRES. Children with PRES were matched with two controls based on age and underlying diagnosis to identify additional risk factors. Fourteen patients developed PRES, with an incidence of 5.9/1000 people/year. Those diagnosed with PRES had commonly described PRES symptoms: hypertension, seizures, nausea/vomiting, altered mental status, and headaches. All patients received an MRI, and most had findings consistent with PRES. HCT was associated with the development of PRES. The use of Etoposide was associated with PRES but comorbidities, steroids and calcineurin inhibitors were not. While PRES was infrequent in this population, it is associated with high morbidity and mortality, with ICU admissions and an overall hospital mortality, due to secondary causes, of 29%.Item Posterior Reversible Encephalopathy Syndrome: The Riley Experience(Office of the Vice Chancellor for Research, 2016-04-08) Meyer, AshleyAbstract: Background: Posterior reversible encephalopathy syndrome (PRES) is a severe neurologic complication associated with many disease processes that can be difficult to diagnose. PRES is a clinicoradiological disease entity represented by characteristic magnetic resonance imaging (MRI) findings, and one of the following clinical features: seizures, headaches, altered levels of mental status, and cortical blindness. Despite growing recognition, debate about the true cause and risk factors remain. To date, this is the largest retrospective chart review of pediatric patients with PRES and evaluates patients across a wide variety of diagnoses. Methods: Pediatric patients presenting to Riley Hospital for Children between January 1, 2003 and December 31, 2014 for PRES were identified retrospectively. Chart review identified true cases of PRES, and underlying diagnosis and risk factors. Of the 129 patients identified, 86 were confirmed cases of PRES. Results: The underlying diagnosis in patients presenting with PRES mainly included nephrogenic diseases, oncologic disease, and pregnancy. Due to the broad range of underlying etiologies, no class of medications was identified as a cause. However, hypertension was strongly associated with development of PRES. Of the 86 confirmed cases, 82 had complete data for analysis revealing 80 patients with hypertension at the onset of symptoms (97.6%). Underscoring the severity of the disease, 63 of the 86 confirmed cases of PRES required pediatric intensive care (73%). Despite the severity of the syndrome, recognition and appropriate therapy allowed for improvement in the majority of patients. Four patients died from their underlying disease process and one patient developed a seizure disorder. Conclusion: PRES is severe complication that can impact patients across a variety of diseases. Close attention must be paid to diseases associated with hypertension. Although previously thought to be a result of direct cytotoxic effects of medication, this study shows hypertension is more strongly associated with development of PRES than medications. While generally reversible, symptoms are often severe enough to require treatment in an intensive care unit. Early diagnosis and correction of blood pressure is important for optimum patient care.