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
Presentation
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.
Imaging
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.
Diagnosis:
Posterior reversible encephalopathy syndrome (PRES)
Suggested articles
Hamid M, Ghani A, Micaily I, Sarwar U, Lashari B, Malik F.J Community Hosp Intern Med Perspect. 2018 Jun 12;8(3):130-133.
2. Posterior reversible encephalopathy syndrome after bevacizumab therapy in a normotensive patient.
Abbas O, Shamseddin A, Temraz S, Haydar A.BMJ Case Rep. 2013 Feb 21;2013
3. Posterior reversible encephalopathy syndrome (PRES): presentation, diagnosis and treatment.
Parasher A, Jhamb R.Postgrad Med J. 2020 Oct;96(1140):623-628.
