A Grave Outcome of Posterior Reversible Encephalopathy Syndrome in a Patient Receiving Avastin (Bevacizumab) for Metastatic High-Grade Serous Ovarian Cancer

Abstract

A 45-year-old female developed neurological symptoms and elevated diastolic blood pressure while on bevacizumab (Avastin) and gemcitabine for recurrent carboplatin-resistant high-grade serous ovarian cancer. A brain MRI diagnosed our patient with posterior reversible encephalopathy syndrome. We are discussing her presenting symptoms in this paper as well as the management and the outcome. We emphasize the importance of keeping this rare but very serious complication in all patients receiving bevacizumab.

Keywords: Bevacizumab; Posterior reversible encephalopathy syndrome.

Fig. 1

MRI FLAIR sequence axial cuts (a, b) and ADC map (c) showing bilateral cerebellar, occipital cortical and subcortical as well as bilateral basal ganglia, frontal cortical, thalamic and brainstem patches and spots of abnormal bright signal (vasogenic edema) with a high ADC value. An MRI post contrast axial cut (d) shows posterior cerebellar patchy nodular and leptomeningeal enhancement.

Fig. 2

MRI FLAIR sequence axial cuts (a, b) 21 days after therapy for PRES, showing almost a total resolution of the edema bright signal apart from the small residue at occipital regions.