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Welcome to the April, 2013 edition of SciEP newsletter, providing monthly summaries of articles on science & education related topics of interest to scientist and professionals. The mission of our journals is to provide an open access forum for publishing new findings on issues pertinent to scientific and academic field. We also invite you to submit original research papers, review articles, short reports, or case studies are considered for publication in our Multidisciplinary Journals.

American Journal of Public Health Research
DOI: 10.12691/ajphr-1-1-3

The Implementation of a Tele-Homecare System with Service Oriented Architecture and HL7 Message Transmission Standard
Ching-Sung Wang

American Journal of Medical and Biological Research
DOI: 10.12691/ajmbr-1-1-2

The Influence of Ethanol on Pyruvate Kinases Activity in Vivo, in Vitro, in Silico
Lelevich Sergey Vladimirovich, Khrustalev Vladislav Victorovich, Barkovsky Eugene Victorovich, Shedogubova Tatyana Aleksandrovna

American Journal of Medical Sciences and Medicine
DOI: 10.12691/ajmsm-1-1-1

Clinical and Histological Features in Wegener Granulomatosis
Li Cavoli Gioacchino, Passantino Rita, Bono Luisa, Tortorici Calogera, Ferrantelli Angelo, Giammarresi Carlo, Rotolo Ugo

American Journal of Infectious Diseases and Microbiology
DOI: 10.12691/ajidm-1-1-2

The Curse of Lymphatic Filariasis: Would the Continual Use of Diethylcarbamazine Eliminate this Scourge in Papua New Guinea?
Anne Lanham, Lillian Mwanri

We have released issues of some journals on February 2013.
American Journal of Public Health Research
American Journal of Medical Sciences and Medicine
American Journal of Medical and Biological Research
American Journal of Pharmacological Sciences
American Journal of Clinical Medicine Research
American Journal of Nursing Research
American Journal of Cancer Prevention
American Journal of Medicine Studies
American Journal of Infectious Diseases and Microbiology
American Journal of Cardiovascular Disease Research
American Journal of Biomedical Research
American Journal of Mechanical Engineering
American Journal of Microbiological Research
Journal of Preventive Medicine
American Journal of Food and Nutrition
American Journal of Hypertension Research
American Journal of Sports Science and Medicine
Journal of Cancer Research and Treatment
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Gemcitabine and Cisplatin Induced Reversible Posterior Leukoencephalopathy Syndrome: A Case Report

Erkan Dogan*, Cemile Ayse Gormeli, Mehmet Fatih Ozbay, Edip Gonullu, Alper Can, Harun Arslan

Department of Medical Oncology, Yuzuncu Yil University Medical Faculty, Van,Turkey

Abstract: Background: Reversible Posterior Leukoencephalopathy Syndrome (RPLS) is a rare clinic-radiological condition. The clinical characteristics of this syndrome are headache, seizures, visual disturbances, confusion, and changes in mental status and focal neurological signs. The radiological characteristic of RPLS is bilateral symmetrical reversible vasogenic edema in the grey and white matter of the posterior part of the parietal-occipital lobes, consistent with hyperintensity in magnetic resonance imaging and computer tomography scans of the brain. Herein we report RPLS during the therapy with gemcitabine and cisplatin in a female patient with pancreatic cancer. Case Report: A 66-year-old female patient was admitted to the hospital because of abdominal pain. The results of computer tomography scans of the abdomen showed a 6-cm mass lesion in the tail of the pancreas and multiple metastatic lesions in the liver. A ‘tru-cut’ biopsy of the liver lesion proved to be consistent with adenocarcinoma. A combination chemotherapy regimen consisting of gemcitabine and cisplatin was planned. During this therapy, RPLS developed as a complication. Subsequent administration of chemotherapy was cancelled, and antihypertensive and anti-edema treatments were begun. Following this treatment the patient’s symptoms rapidly improved. There was a dramatic decline in vasogenic edema in control MRI scans which were performed a week later. Conclusion: Failure to diagnose the RPLS and correct the precipitating cause may result in catastrophic permanent brain injury or even death.

Keywords: reversible posterior leukoencephalopathy syndrome, gemcitabine, cisplatin

Received June 17, 2015; Revised July 18, 2015; Accepted August 02, 2015

Citation: Erkan Dogan, Cemile Ayse Gormeli, Mehmet Fatih Ozbay, Edip Gonullu, Alper Can, Harun Arslan, Gemcitabine and Cisplatin Induced Reversible Posterior Leukoencephalopathy Syndrome: A Case Report. American Journal of Cancer Prevention, 3 (4). 74-76. January 2015. doi:10.12691/ajcp-3-4-2

1. Introduction

Reversible Posterior Leukoencephalopathy Syndrome (RPLS) was first defined by Hinchey et al. in 1996 [1]. RPLS is a rare clinic-radiological condition, but with each passing day is more frequently diagnosed. The clinical characteristics of this syndrome are headache, seizures, visual disturbances, confusion, and changes in mental status and focal neurological signs [1]. The radiological characteristic of RPLS is bilateral symmetrical reversible vasogenic edema in the grey and white matter of the posterior part of the parietal-occipital lobes, consistent with hyperintensity in magnetic resonance imaging and computer tomography scans of the brain [1].

2. Case Report

A 66-year-old female patient was admitted to the hospital because of abdominal pain. The results of computer tomography scans of the abdomen showed a 6-cm mass lesion in the tail of the pancreas and multiple metastatic lesions in the liver. A ‘tru-cut’ biopsy of the liver lesion proved to be consistent with adenocarcinoma. A combination chemotherapy regimen consisting of gemcitabine and cisplatin was planned. The patient had no history of neurological disease or hypertension. Following the first cycle of chemotherapy, sudden loss of vision, headache, dizziness and problems with balance occurred. Therefore, magnetic resonance imaging (MRI) scans of the cranium were urgently taken. The MRI results revealed a vasogenic edema characterized by diffuse, symmetrical hyperintense areas in T2 and FLAIR images, in the bilateral centrum semiovale, periventricular areas and bilateral occipital lobes (Figure 1). The patient’s blood pressure was determined to be 170/95 mm Hg. RPLS has been diagnosed in patients with similar findings. Subsequent administration of chemotherapy was cancelled, and antihypertensive and anti-edema treatments were begun. Following this treatment the patient’s symptoms rapidly improved. There was a dramatic decline in vasogenic edema in control MRI scans which were performed a week later (Figure 2).

Figure 1. RPLS Typical Findings in MRI

Figure 2. Post-Treatment Findings in Control MRI

3. Discussion

Pathophysiological mechanisms in RPLS have not been fully elucidated. No single antineoplastic class or agent, or any other disease, has been consistently associated with RPLS. Until now, the documented factors that play a role in the etiology of RPLS are systemic hypertension, cytotoxic and immunosuppressive drugs, bevacizumab, cisplatin, gemcitabine, cyclosporin A, cytarabine, dexamethasone, interferon, metotreksat, rituksimab, sorafenib, tacrolimus, pre-eclampsia/eclampsia, interaction with general anesthesia and renal failure [2,3,4]. Proposed pathophysiological mechanisms involved in the development of this syndrome are cerebral vasospasm and ischemia, with the resulting fluid extravasation causing disturbance of cerebrovascular autoregulation in affected vascular areas of the brain [5,6]. In this syndrome, clinical and radiological findings are nonspecific and do not suffice for the differential diagnosis of the etiologic causes. By eliminating the underlying disease or condition causing RPLS, radiological and clinical findings are typically resolved within 2 weeks [7]. Otherwise, permanent neurological damage may arise with progression to infarction, hemorrhage or even death [3,8].

The typical finding in RPLS is vasogenic edema in the bilateral parieto-occipital region, characterized by hyperintensity in T2-weighted and FLAIR imagings in MRI. Lesions usually disappear with proper treatment. However, the possibility of lesions improving varies depending on the underlying disease, the localization of the lesions and signal characteristics in MRI. Early diagnosis is the most critical factor in the treatment of this syndrome.

4. Conclusion

RPLS is a rare complication of chemotherapy in cancer patients. Accordingly, failure to diagnose the syndrome and correct the precipitating cause may result in catastrophic permanent brain injury or even death.

References

[1]   | Hinchey J, Chaves C, Appignani B, et al. A reversible posterior leukoencephalopathy syndrome, N Engl J Med, 334 (8), 494-500, 1996.
[2]   | Dogan E, Aksoy S, Arslan C, Dede DS, Altundag K. Probable sorafenib-induced reversible encephalopathy in a patient with hepatocellular carcinoma. Med Oncol, 27 (4), 1436-7, 2010.
[3]   | Rajasekhar A, George TJ Jr. Gemcitabine-induced reversible posterior leukoencephalopathy syndrome: a case report and review of the literature.Oncologist, 12 (11), 1332-5, 2007.
[4]   | Fugate JE, Claassen DO, Cloft HJ, Kallmes DF, Kozak OS, et al. Posterior reversible encephalopathy syndrome: associated clinical and radiologic findings. Mayo Clin Proc, 85(5), 427-32, 2010.
[5]   | Port JD, Beauchamp NJ Jr. Reversible intracerebral pathologic entities mediated by vascular autoregulatory dysfunction. Radiographics, 18 (2), 353-67, 1998.
[6]   | Bartynski WS, Boardman JF. Catheter angiography, MR angiography, and MR perfusion in posterior reversible encephalopathy syndrome. Am J Neuroradiol. 29 (3), 447-55, 2008.
[7]   | Sclafani F, Giuseppe G, Mezynksi J, Collins C, Crown J. Reversible posteriorleukoencephalopathy syndrome and bevacizumab in breast cancer. J Clin Oncol, 30 (26), e257-9, 2012.
[8]   | Femia G, Hardy TA, Spies JM, Horvath LG. Posterior reversible encephalopathy syndrome following chemotherapy with oxaliplatin and a fluoropyrimidine: a case report and literature review. Asia Pac J Clin Oncol, 8 (2), 115-22, 2012.