Posterior reversible encephalopathy syndrome (PRES) after bevacizumab therapy for metastatic breast cancer

Case contributed by Dr Danai Chourmouzi, Dr Nikolaos Touroutoglou. 

Patient Data

AGE: 50 years

GENDER: Female


A 50-year-old woman with known breast cancer stage IV with liver metastasis treated with bevacizumab presented with headaches, tonic-clonic seizure and altered mental status.

On physical examination was pertinent for confusion and agitation.

Her  blood pressure (BP)  was high with a range of 190–210 mmHg systolic BP. 


Brain MRI





The MRI demonstrates patchy hyperintense signal changes on T2, FLAIR and DW images  involving the cortical and subcortical regions in frontal, parietal  and  occipital lobes  bilaterally  with enhancement after contrast administration.



The follow-up images after improvement in clinical status with control of blood pressure and  prevention of seizures shows complete resolution of changes. 

Case Discussion

Posterior reversible encephalopathy syndrome (PRES) (also known as hypertensive encephalopathy) is a neurotoxic state occurring secondary to the inability of posterior circulation to auto-regulate in response to acute changes in blood pressure. Bevacizumab, a monoclonal antibody vascular endothelial growth factor (VEGF) inhibitor, has been implicated as the cause of PRES due to dysregulation of the blood-brain barrier.


Posterior reversible encephalopathy syndrome (PRES)

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