Posterior reversible encephalopathy syndrome case report in an untreated, normotensive, ovarian cancer patient in the pr
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CASE REPORT
Open Access
Posterior reversible encephalopathy syndrome case report in an untreated, normotensive, ovarian cancer patient in the presence of paraneoplastic antibodies Elad Barber1,2,3* , Rijini Nugzar3,4, Vitaly Finkelshtein3,5, Alexander Puzhevsky3,6 and Tally Levy1,2,3
Abstract Background: Posterior reversible encephalopathy syndrome (PRES) is a rare neurological condition with many associated risk factors. The presentation varies and consists of seizures, impaired visual acuity or visual field deficits, disorders of consciousness, headaches, confusion and focal neurological deficits. The diagnosis relies on clinical presentation and MRI findings. Treatment and prognosis are related to the underlying etiology. Case presentation: We present a 58-year-old woman with ovarian cancer who developed symptoms and radiologic signs of PRES with no apparent trigger other than a sudden increase in blood pressure for the first time in her life and before any treatment has begun. Antibodies to collapsin response-mediator protein-5 (CRMP-5), a malignancy related paraneoplastic protein, were identified in her CSF. Conclusions: We present a novel and intriguing association between PRES and antibodies against CRMP-5 which may highlight a new etiology for this condition. Keywords: Posterior reversible encephalopathy syndrome, PRES, Paraneoplastic antibodies, CRMP5, Ovarian cancer
Background Posterior reversible encephalopathy syndrome (PRES) is an acute, rare, reversible, neurological condition and is characterized by a variety of symptoms including seizures, impaired visual acuity or visual field deficits, disorders of consciousness, headaches, confusion and focal neurological deficits [1]. The main speculated etiology is hypertension causing failed autoregulation and hyper-perfusion consequentially leading to vascular cerebral dysregulation [2, 3]. Other PERS associated risk factors have also been shown to affect the capillary system. Immunosuppression and * Correspondence: [email protected] 1 Division of Gynecologic Oncology, Wolfson Medical Center, Holon, Israel 2 Department of Obstetrics and Gynecology, The Edith Wolfson Medical Center, P.O. Box 5, 58100 Holon, Israel Full list of author information is available at the end of the article
chemotherapy have been shown to alter capillary morphology [4, 5]. Malignant tumors can cause activation of endothelial cells, proliferation and neovascularization mainly through the vascular endothelial growth factor (VEGF) family influencing endothelial motility and leading to neovascularization [4]. The prompt diagnosis of atypical presentations of PRES is important to avoid delays in diagnosis and treatment, as is identification of complicating factors which may adversely affect patient prognosis. Moreover, treatment of PRES depends on the underlying etiology along with antihypertensive and antiepileptic therapy, when needed [6]. Consequently, it is important to study and better characterize the predisposing factors that can bring about the appearance of this conditio
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