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Posterior Reversible Encephalopathy Syndrome (PRES) Complicated by Subarachnoid Hemorrhage Induced by Chemotherapy: A Rare Case and Literature Review
Department of Medical Oncology, Hassan II University Hospital Center, Faculty of Medicine and Pharmacy of Fez, Sidi Mohamed Ben Abdellah University, Fez, Morocco
Department of Medical Oncology, Hassan II University Hospital Center, Faculty of Medicine and Pharmacy of Fez, Sidi Mohamed Ben Abdellah University, Fez, Morocco
Department of Medical Oncology, Hassan II University Hospital Center, Faculty of Medicine and Pharmacy of Fez, Sidi Mohamed Ben Abdellah University, Fez, Morocco
Department of Medical Oncology, Hassan II University Hospital Center, Faculty of Medicine and Pharmacy of Fez, Sidi Mohamed Ben Abdellah University, Fez, Morocco
Department of Medical Oncology, Hassan II University Hospital Center, Faculty of Medicine and Pharmacy of Fez, Sidi Mohamed Ben Abdellah University, Fez, Morocco
Department of Medical Oncology, Hassan II University Hospital Center, Faculty of Medicine and Pharmacy of Fez, Sidi Mohamed Ben Abdellah University, Fez, Morocco
Department of Medical Oncology, Hassan II University Hospital Center, Faculty of Medicine and Pharmacy of Fez, Sidi Mohamed Ben Abdellah University, Fez, Morocco
Department of Medical Oncology, Hassan II University Hospital Center, Faculty of Medicine and Pharmacy of Fez, Sidi Mohamed Ben Abdellah University, Fez, Morocco
Department of Medical Oncology, Hassan II University Hospital Center, Faculty of Medicine and Pharmacy of Fez, Sidi Mohamed Ben Abdellah University, Fez, Morocco
Department of Medical Oncology, Hassan II University Hospital Center, Faculty of Medicine and Pharmacy of Fez, Sidi Mohamed Ben Abdellah University, Fez, Morocco
- 1 Department of Medical Oncology, Hassan II University Hospital Center, Faculty of Medicine and Pharmacy of Fez, Sidi Mohamed Ben Abdellah University, Fez, Morocco
- 2 Department of Medical Oncology, Hassan II University Hospital Center, Faculty of Medicine and Pharmacy of Fez, Sidi Mohamed Ben Abdellah University, Fez, Morocco
- 3 Department of Medical Oncology, Hassan II University Hospital Center, Faculty of Medicine and Pharmacy of Fez, Sidi Mohamed Ben Abdellah University, Fez, Morocco
- 4 Department of Medical Oncology, Hassan II University Hospital Center, Faculty of Medicine and Pharmacy of Fez, Sidi Mohamed Ben Abdellah University, Fez, Morocco
- 5 Department of Medical Oncology, Hassan II University Hospital Center, Faculty of Medicine and Pharmacy of Fez, Sidi Mohamed Ben Abdellah University, Fez, Morocco
- 6 Department of Medical Oncology, Hassan II University Hospital Center, Faculty of Medicine and Pharmacy of Fez, Sidi Mohamed Ben Abdellah University, Fez, Morocco
- 7 Department of Medical Oncology, Hassan II University Hospital Center, Faculty of Medicine and Pharmacy of Fez, Sidi Mohamed Ben Abdellah University, Fez, Morocco
- 8 Department of Medical Oncology, Hassan II University Hospital Center, Faculty of Medicine and Pharmacy of Fez, Sidi Mohamed Ben Abdellah University, Fez, Morocco
- 9 Department of Medical Oncology, Hassan II University Hospital Center, Faculty of Medicine and Pharmacy of Fez, Sidi Mohamed Ben Abdellah University, Fez, Morocco
- 10 Department of Medical Oncology, Hassan II University Hospital Center, Faculty of Medicine and Pharmacy of Fez, Sidi Mohamed Ben Abdellah University, Fez, Morocco
Journal of Cancer Therapy·Volume 17 (2026)·Pages 13–20·Published 2 January 2026·DOI10.4236/jct.2026.171003
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Abstract
Posterior Reversible Encephalopathy Syndrome (PRES) is a rare neurological entity characterized by vasogenic cerebral edema, often triggered by hypertension, renal failure, preeclampsia, certain immunosuppressive drugs, or chemotherapeutic agents. We report the case of a 68-year-old woman with multifocal metastatic intrahepatic cholangiocarcinoma who developed PRES complicated by subarachnoid hemorrhage following the administration of the third cycle of FOLFOX chemotherapy. The clinical picture included headaches, visual disturbances, and recurrent generalized tonic-clonic seizures. Brain magnetic resonance imaging (MRI) confirmed the diagnosis by showing bilateral and symmetrical T2/FLAIR hyperintensities predominantly in the parieto-occipital regions, consistent with vasogenic edema, associated with minimal leptomeningeal bleeding signs. Management consisted of immediate discontinuation of chemotherapy, strict blood pressure control, and anticonvulsant therapy, leading to a rapidly favorable outcome. This case highlights the rarity of oxaliplatin as a causative agent and the importance of heightened clinical vigilance for any acute neurological symptom in a patient undergoing chemotherapy, to enable early management and improve prognosis.
KeywordsPosterior Reversible Encephalopathy Syndrome (PRES)OxaliplatinFOLFOXSubarachnoid HemorrhageChemotherapyNeurological Complications
- Hinchey, J., Chaves, C., Appignani, B., Breen, J., Pao, L., Wang, A., et al. (1996) A Reversible Posterior Leukoencephalopathy Syndrome. New England Journal of Medicine , 334, 494-500. https://doi.org/10.1056/nejm199602223340803
- Stott, V.L., Hurrell, M.A. and Anderson, T.J. (2005) Reversible Posterior Leukoencephalopathy Syndrome: A Misnomer Reviewed. Internal Medicine Journal , 35, 83-90. https://doi.org/10.1111/j.1445-5994.2004.00750.x
- Elsevier Masson (2024) Encéphalopathie postérieure réversible (PRES). EMC-Neuro-logie, Article 17-046-D-17, Elsevier.
- Hottinger, A.F., Perez, L., Hägele-Link, S. and Hundsberger, T. (2016) Complications neurologiques des traitements anticancéreux. Revue Médicale Suisse , 12, 840-843. https://doi.org/10.53738/revmed.2016.12.516.0840
- Janjua, T.K., Hassan, M., Afridi, H.K. and Zahid, N.A. (2017) Oxaliplatin-Induced Posterior Reversible Encephalopathy Syndrome (PRES). BMJ Case Reports , 2017, bcr-2017-221571. https://doi.org/10.1136/bcr-2017-221571
- Van Pelt, Q., et al . (2020) Posterior Reversible Encephalopathy Syndrome Secondary to Oxaliplatin-Based Chemotherapy and Regorafenib in Metastastic Colorectal Cancer : Case Reports and Literature Review. https://www.ageb.be/Articles/Volume%2083%20(2020)/Fasc1/07-Van%20Pelt.pdf
- Fugate, J.E. and Rabinstein, A.A. (2015) Posterior Reversible Encephalopathy Syndrome: Clinical and Radiological Manifestations, Pathophysiology, and Outstanding Questions. The Lancet Neurology , 14, 914-925. https://doi.org/10.1016/s1474-4422(15)00111-8
- Femia, G., Hardy, T.A., Spies, J.M. and Horvath, L.G. (2012) Posterior Reversible Encephalopathy Syndrome Following Chemotherapy with Oxaliplatin and a Fluoropyrimidine: A Case Report and Literature Review. Asia - Pacific Journal of Clinical Oncology , 8, 115-122. https://doi.org/10.1111/j.1743-7563.2012.01544.x
- Bartynski, W.S. (2008) Posterior Reversible Encephalopathy Syndrome, Part 1: Fundamental Imaging and Clinical Features. American Journal of Neuroradiology , 29, 1036-1042. https://doi.org/10.3174/ajnr.a0928
- Brady, E., Parikh, N.S., Navi, B.B., Gupta, A. and Schweitzer, A.D. (2018) The Imaging Spectrum of Posterior Reversible Encephalopathy Syndrome: A Pictorial Review. Clinical Imaging , 47, 80-89. https://doi.org/10.1016/j.clinimag.2017.08.008
- Tamaki, K., Sadoshima, S., Baumbach, G.L., Iadecola, C., Reis, D.J. and Heistad, D.D. (1984) Evidence That Disruption of the Blood-Brain Barrier Precedes Reduction in Cerebral Blood Flow in Hypertensive Encephalopathy. Hypertension , 6, 175-181. https://doi.org/10.1161/01.hyp.6.2_pt_2.i75