Posterior reversible encephalopathy syndrome after intrathecal methotrexate infusion: a case report and literature update

Posterior reversible encephalopathy syndrome (PRES) is a rare clinical-radiological entity characterised by seizures, severe headache, mental status instability and visual disturbances. Hypertension is typically present. We report a case of a 13-year old boy with Burkitt lymphoma/leukaemia, who presented with posterior leukoencephalopathy 24 hours after intrathecal methotrexate (MTX) infusion. The child presented with headache, seizures, elevated blood pressure and gradual deterioration of his neurological status. Midazolam, dexamethazone and furosemide were initiated leading to reduction of cerebral oedema and clinical improvement. A thorough literature review is discussed in this report. Pathophysiology of leukoencephalopathy remains unclear. It develops within 5-14 days after intrathecal MTX and resolves within a week usually without permanent neurological sequelae. Broad use of MRI has led to an increasing number of identified cases of PRES. Treatment approach is mainly to manage the underlying cause of PRES. Prognosis is generally benign; however delayed diagnosis and improper management may result in permanent brain insult.

Brain natriuretic peptide as a cardiotoxicity biomarker in children with hematological malignancies

AIM

Aim of our study was to evaluate BNP as early cardiotoxicity biomarker after completion of chemotherapy in twenty children with hematological malignancies at diagnosis (t=0) and after completion of intensive chemotherapy (t=1).

METHODS

Demographic data, underlying disease, cumulative anthracyclines dose, measurement of serum BNP and evaluation of systolic function of left ventricle with ejection fraction (EF) and shortening fraction (FS) in both times . Pathological values for EF and FS were found in 4 (20%) and 1 (5%) patient at t=1, while respective values were normal at diagnosis.

RESULTS

Mean BNP values at t=0 were 59.09±19.95 pg/mL and differ significantly from values at t=1 (153.22±29.14 pg/mL) (P=0.04). Mean value of EF also differed significantly (75.42±4.11% vs. 69.87±10.51%, P=0.04). No statistic difference was found regarding FS values at both (P=0.102).

CONCLUSION

Present data indicate that anthracyclines related cardiotoxicity is registered in children with hematological malignancies and BNP represents a useful biomarker of myocardial dysfunction.