الفهرس 
IntroductionOnly 14 pages are availabe for public view
 |  | from | 135 |  |  |
| | | from | 135 | | |
Abstract
SUMMARY UMMARY
osterior reversible encephalopathy syndrome (PRES), is a clinico-radiological diagnosis characterized by a spectrum of symptoms, including altered mental status, headache, seizures and visual changes. Magnetic resonance imaging (MRI) finding including the evidence of hyperintense signal change in the cortical-subcortical areas.
We aimed to study the risk factors, clinical and radiological patterns of PRES in pediatric cancer patients, and also to assess the clinical and radiological outcomes.
This retrospective study included pediatric cancer patients who were developed PRES during the course of their treatment at the Children’s Cancer Hospital Egypt (CCHE-57357) from January 2013 to June 2017.
The clinical and radiological data of the studied patients were collected and reviewed. All MRI findings were revised by the specialized neuroradiologist to detect different kinds of PRES.
Among the 50 patients with PRES, 62% of the patients were <10 years of age, while 38% were ≥10 years of age with mean age 8.5 years. Twenty-three patients were males (46%) and 27 were females (54%). With Male: Female ratio 1:1.17.
P
Summary
86
(74%) were less than 6 months while (26%) were more than 6 months from start of treatment. PRES was most common with leukemia and lymphoma (64%) followed by solid tumors (26 %) and post bone marrow transplantation (10%).
Forty patients (80%) received chemotherapy or immunosuppression during last 14 days before the PRES development. Hypertension was presented in 43 patients (86%).
Regarding the clinical features, Convulsions was the most common clinical finding (90%), followed by altered mental status (AMS) (68%), headache (28%), visual impairment (16%) and finally motor power affection (12%). While the laboratory findings at the time of PRES revealed that, anemia was the most common laboratory diagnosis at the time of PRES development (68%) followed by thrombocytopenia (62%), hypokalemia (50%), hypomagnesaemia (48%), hyocalcemia (36%) and hypernatremia (34%). While elevated kidney functions, liver functions were found only in (24%) for each respectively.
On the other hand, Regarding the MRI findings at the onset of diagnosis, most of the patients had occipitoparietal affection. Other affected areas like frontal involvement was seen (32%), temporal lobe involvement (22%). Also there were (12%) had cerebellar affection, (8%) had basal ganglia affection and (6%) only had thalamic involvement. In addition to bilateral PRES presented (80%) and typical PRES was found
Summary
87
in (58%), atypical PRES (42%). The atypical findings were presented in 9 patients (18%). 5 as restricted diffusion (10%), 4 as enhancement (8%).
Regarding the outcome, 40 patients (80%) had complete resolution from the PRES symptoms within a period ranging from 0 to 10 days with mean time 2 days and SD 2.18. regarding the radiological outcome 30 patients (60%) had complete radiological resolution within 1st month follow up.
On the other hand, regarding the overall mortality, thirty seven patients (74%) survived at the time of the study. (66%) with good neurological outcome and (8%) had a neurological deficit. While 11 patients (22%) died; three patients (6%) died due to PRES, 8 patients (16%) died from other causes, one patient (2%) with unknown cause of death and 2 patients (4%) lost follow up. Five patients died during 1st 3 months following PRES development, while the remaining 6 patients died after 3 months, ranging from 1 month to 2 years, with median 185 days.
In our study Patients who developed PRES ≥ 6 months from start of chemotherapy had poorer prognosis compared (p value=0.001), and the patients who had other comorbidities rather than chemotherapy or immunosuppressive drugs during 14 days before onset of PRES or patients who were on maintenance TXV were poor prognosis (P-value 0.001).
Summary
88
The patients who had GTC had a poor prognosis (P- value 0.054). Also patients who developed motor power affection had poor outcome (p value <0.0001). In addition to patients who developed status epilepticus had poor prognosis (p value 0.004).
Patients who developed MRI changes at frontal lobes had poor prognosis (P value 0.034). Also patients who developed MRI changes at thalamus had poor prognosis (P value 0.006). While the atypical PRES had bad prognosis compared to typical PRES (p-value 0.04)