Dexamethasone
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Reversible posterior encephalopathy syndrome? in children: 2 case reports Two children with recurrent anaplastic ependymoma developed posterior reversible encephalopathy syndrome [PRES] after recent treatment with dexamethasone. One patient had also received hydrocortisone. A 4-year-old boy, who had completed chemotherapy in 2007 and radiotherapy in 2008, underwent surgery in 2010 and developed intra- and peri-operative haemodynamic instability. He had not been receiving steroids presurgically, and was weaned from postoperative IV dexamethasone 4mg every 6 hours to 1mg orally twice daily [duration of treatment not stated]. After 1 week, a second operation was undertaken and hypertension recurred; he also developed seizures and altered mental status. He received antihypertensive therapy and levetiracetam; MRI was consistent with PRES. He improved and was discharged receiving levetiracetam and clonidine. At last follow-up he had recovered. A 7-year-old boy had last received radiotherapy in 2006 and chemotherapy in 2008. He had received steroid therapy for 1 year, with a dexamethasone taper for 5 months [dosage, route and time to reaction onset not stated], then hydrocortisone 0.5mg twice daily for 9 months. He underwent surgery in 2010, and 5 days afterward, presented with hypertension, seizures and neurological deterioration. T2 enhancements on MRI were congruent with PRES. He received antihypertensives and levetiracetam and was discharged with levetiracetam and clonidine; at last follow-up he had recovered. Author comment: "[B]oth children may have been mildly immunosuppressed as they had recurrent brain tumor, chronic illness, and recent dexamethasone administration. Each child had a history of chemotherapy and radiation but was not actively undergoing such treatments when he presented with PRES." Hayden Gephart MG, et al. Perioperative posterior reversible encephalopathy syndrome in 2 pediatric neurosurgery patients with brainstem ependymoma: Report of 2 cases. Journal of Neurosurgery: Pediatrics 7: 235-237, No. 3, Mar 2011. Available from: URL: http://dx.doi.org/10.3171/2010.12.peds10299 803053856 USA
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Reactions 7 May 2011 No. 1350
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