Acute Neurological Complication of Chemotherapy: A Case of Posterior Reversible Encephalopathy Syndrome Following Chemotherapy with Oxaliplatin and a Fluoropyrimidine

Abstract

Posterior reversible encephalopathy syndrome (PRES) is a transient neuro-radiological condition marked by seizures, altered consciousness, and visual disturbances. MRI typically reveals reversible hyperintense lesions in the posterior cerebral regions. While most cases are reversible, PRES remains a rare and potentially severe complication of chemotherapy. This article aims to describe the clinical and radiological features of this chemotherapy-induced complication, supported by a review of similar cases in the literature. We report a case from the oncology department of Hassan II University Hospital in FES, of a 44-year-old male patient with no comorbidities, who was admitted for sudden bilateral blindness several hours after the administration of his first course of chemotherapy based on 5-FU and oxaliplatin for gastric cancer, he was admitted to the oncology emergency unit. The patient’s blood pressure was within normal limits. Brain MRI revealed bilateral hyperintensities on FLAIR sequences involving the parieto-occipital regions. The patient was treated with intravenous corticosteroids and clonazepam with strict monitoring of blood pressure. The neurological symptoms fully regressed over the course of a few days. These findings, in correlation with the clinical picture, led to the diagnosis of posterior reversible encephalopathy syndrome (PRES). This case highlights the importance of considering PRES in any cancer patient presenting with acute neurological symptoms, even in the absence of hypertension.