Persistent neurophysiological abnormalities in Posterior Reversible Encephalopathy Syndrome: a three-month EEG and VEP follow-up in 5 children with acute lymphoblastic leukemia

Simona Maccora, Ilaria Maccora, Antonella Grigoli, Paolo D'Angelo, Giuseppe Santangelo, Andrea Santangelo, Crocifissa Maria Ministeri



Posterior Reversible Encephalopathy Syndrome (PRES) is a well described complication of cancer chemotherapy.

Case series

We have recently observed PRES in 5 children affected with acute lymphoblastic leukaemia. All children presented with altered mental status; visual disturbances, headache and seizures were other common clinical features. Magnetic resonance imaging showed cortical and subcortical hyperintensities on fluid-attenuated inversion recovery and diffusion weighted sequences, mainly located in the occipital and parietal regions, strongly consistent with PRES. All patients completely recovered from their neurologic deficits in about six days. Electroencephalograms (EEG) were performed at onset and three months after syndrome recovery in all patients. Visual evoked potentials (VEPs) were recorded only three months after syndrome onset. Primary objective of this case series was to determine the potential role of neurophysiological investigations in a three-month follow-up of young patients with PRES.

In our small cohort, acute lymphoblastic leukemia, hypertension and immunosuppressants played a crucial role in pathogenesis of PRES. Clinical and radiological features allowed excluding methotrexate-induced encephalopathy. Despite a complete clinical recovery, we could detect residual neurophysiological abnormalities in four patients. Both EEG and VEP abnormalities were observed in 1 patient; 1 patient had only altered EEG and 2 patients exhibited only altered VEPs. VEP anomalies usually consisted of bilateral increased latencies and durations of main waveforms.


EEG and VEPs proved to be effective to define residual neurological dysfunction in patients with PRES. In view of high incidence of visual disturbances and occipital involvement, we observed that VEPs might show some demyelinating features and could arrange with occipital distribution of radiological findings in patients with history of PRES.


Posterior Reversible Encephalopathy Syndrome; Acute Lymphoblastic Leukemia; electroencephalography; Visual Evoked Potentials; methotrexate

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