Abstract:
The term posterior reversible encephalopathy syndrome (PRES) refers to an acute syndrome characterised by a range of neurological symptoms and posterior transient changes on neuroimaging. Common clinical presentation includes headache, confusion, visual disturbances, seizures, and focal neurological deficit. With the advancement and increasing availability of neuroimaging, this syndrome is increasingly recognised. There are several underlying causes for PRES, including certain medications. Tyrosine kinase inhibitors (TKIs) such as pazopanib can increase the risk of developing PRES by markedly elevating the blood pressure due to its effect of inhibition of vascular endothelial growth factor receptors (VEGFRs). We have reported a case of a 55-year-old male patient with the clear cell type of renal cell carcinoma (RCC) who developed PRES within a short period after starting pazopanib therapy. Seven days after the initiation of the Pazopanib, he began complaining of a headache in the evening and reported three episodes of vomiting. Following morning he had a generalised tonic-clinic seizure and presented with low Glasgow Coma Scale of 9/15 points. His BP on presentation was 200/100 mmHg and a magnetic resonance imaging (MRI) scan showed cortical and sub cortical hyper intensities involving bilateral parieto-occipital lobe. With the effective control of his blood pressure and discontinuation of pazopanib his symptoms quickly improved. On subsequent follow-up MRI scan after four weeks his typical lesion of PRES resolved completely. This case represents rare association of pazopanib causing PRES and importance of its early recognition and timely discontinuation of the medication to prevent permanent neurological damage and improve patient’s overall outcome.
Audience Take Away Notes:
- The audience can gain insights into the prevalence of PRES associated with pazopanib therapy and identify potential risk factors that may increase susceptibility to this condition.
- The presentation can provide a detailed understanding of the typical clinical symptoms and diagnostic features of PRES, aiding in early recognition and prompt management.
- Attendees can learn about effective management strategies for PRES, including the importance of discontinuing pazopanib and controlling blood pressure.
- The poster can discuss the potential long-term neurological consequences of PRES and highlight the need for ongoing monitoring and follow-up.
