Side Effect: PRES Syndrome

What is PRES Syndrome?

Posterior reversible encephalopathy syndrome (PRES) is a neurological disorder that affects the brain, leading to a variety of symptoms. It can occur suddenly in people with a variety of medical conditions, including patients with cancer.

What does PRES Syndrome look like?

PRES can present with a variety of symptoms, including headaches, seizures, vision problems, and altered mental status. Some patients may also experience nausea, vomiting, and high blood pressure. On a brain scan, the provider looks for something called “white matter” which can be seen on a magnetic resonance image (MRI). Typically, this white matter seen and symptoms a patient with cancer presents with are reversible with treatment.

Who gets PRES Syndrome?

PRES can affect patients of all ages and is associated with a variety of medical conditions, including patients with cancer. Chemotherapy, stem cell transplant recipients, and childhood cancers have all been linked as causing PRES. PRES syndrome is associated with medical conditions that put a patient at risk for suppressing the immune system. While that includes high blood pressure, renal disease, autoimmune disorders, and infections, chemotherapy is the most common factor. The most common chemotherapy regiments to cause PRES are below:

• Paclitaxel (Taxol®)
• Bevacizumab (Avastin®, Mvasi®, Zirabev®)
• Irinotecan (Camptosar®)
• Gemcitabine (Gemzar®)
• Cisplatin (Platinol®)
• Topotecan (Hycamtin®)

How to prevent PRES Syndrome

Preventing PRES in patients with cancer can be challenging, as it’s often related to the treatment they are receiving, or an underlying medication condition as stated above. Recognizing and treating high blood pressure (which is a known risk factor for PRES) may help reduce the incidence in patients with cancer. Other strategies include monitoring blood pressure, monitoring labs (especially electrolytes), and monitoring renal function during chemotherapy.

How to treat PRES Syndrome

PRES treatment typically involves discontinuing the causative agent, or managing the underlying problem (electrolyte imbalances, high blood pressure, etc.). In some cases, medications to lower blood pressure or control seizures might be used. Some examples are below:

• Decreasing blood pressure – nicardipine (Cardene®), furosemide (Lasix®)
• Managing seizures – levetiracetam (Keppra®), phenytoin (Dilantin®)
• Decreasing inflammation – mostly corticosteroids including methylprednisolone (Medrol®, Solu-Medrol®), dexamethasone (Decadron®), and prednisone (Deltasone®)

Treatment generally works quickly once PRES is recognized and diagnosed, most patients seeing relief of symptoms within a couple days. It is important to discuss any symptoms with the provider, and understanding early recognition and management is essential to prevention and treatment of PRES.