Gemcitabine and Cisplatin induced posterior reversible encephalopathy syndrome: A case report with review of literature

Abstract

Posterior reversible encephalopathy syndrome (PRES) is a recently described, scarcely documented clinical entity. PRES is caused by various factors, the most common being hypertension, followed by nonhypertensive causes such as renal diseases and immunosuppressive therapy. Recently, some cases have been reported about the association of increased use of cytotoxic and immunosuppressive agents in cancer patients, and relevant reports have increased with advances in radiological examinations. Here, we report a case of gallbladder cancer with liver metastasis undergoing gemcitabine- and cisplatin-based chemotherapy who presented with complaints of seizures, headache, and bilateral lower limb weakness. Thorough clinical examination, biochemical analysis, and radiological evaluation led to diagnosis of PRES. It is important to recognize this syndrome which will facilitate early diagnosis and prompt symptomatic management. Removal of causative agent is an important aspect of management. Studies are needed to identify factors of adverse prognostic significance and to develop neuroprotective strategies.

Keywords: Cisplatin; Gemcitabine; posterior reversible encephalopathy syndrome.

Figure 1

T2-weighed magnetic resonance imaging

Figure 2

Fluid-attenuated inversion recovery hypersensitivity

Figure 3

Diffusion-weighed image

Figure 4

Dominant parieto-occipital pattern