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Rota E, Vallisa D, Morelli N, et al. Iatrogenic Coagulopathy and the Development of Posterior Reversible Encephalopathy Syndrome after L-asparaginase Chemotherapy. J Clin Imaging Sci. 2016;6:7doi: 10.4103/2156-7514.177553.
Rota, E., Vallisa, D., Morelli, N., & Scagnelli, P. (2016). Iatrogenic Coagulopathy and the Development of Posterior Reversible Encephalopathy Syndrome after L-asparaginase Chemotherapy. Journal of clinical imaging science, 67. https://doi.org/10.4103/2156-7514.177553
Rota, Eugenia, et al. "Iatrogenic Coagulopathy and the Development of Posterior Reversible Encephalopathy Syndrome after L-asparaginase Chemotherapy." Journal of clinical imaging science vol. 6 (2016): 7. doi: https://doi.org/10.4103/2156-7514.177553
Rota E, Vallisa D, Morelli N, Scagnelli P. Iatrogenic Coagulopathy and the Development of Posterior Reversible Encephalopathy Syndrome after L-asparaginase Chemotherapy. J Clin Imaging Sci. 2016 Feb 26;6:7. doi: 10.4103/2156-7514.177553. eCollection 2016. PMID: 27014503; PMCID: PMC4785783.
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J Clin Imaging Sci. 2016 Feb 26;6:7. doi: 10.4103/2156-7514.177553. eCollection 2016.

Iatrogenic Coagulopathy and the Development of Posterior Reversible Encephalopathy Syndrome after L-asparaginase Chemotherapy.

Journal of clinical imaging science

Eugenia Rota, Daniele Vallisa, Nicola Morelli, Paola Scagnelli

Affiliations

  1. Department of Neurology, Guglielmo da Saliceto Hospital, Castel San Giovanni, Piacenza, Italy.
  2. Department of Hematology, Guglielmo da Saliceto Hospital, Castel San Giovanni, Piacenza, Italy.
  3. Department of Radiology, Castel San Giovanni Hospital, Castel San Giovanni, Piacenza, Italy.

PMID: 27014503 PMCID: PMC4785783 DOI: 10.4103/2156-7514.177553

Abstract

Posterior reversible encephalopathy syndrome (PRES) is a clinical and radiological syndrome mostly related to hypertension, eclampsia, renal failure, or to chemotherapy and/or immunosuppressive drugs. Although the PRES pathophysiology is multifactorial, hypertension and endothelial dysfunction are hypothesized to be the pivotal factors. Here we report a case of PRES in an adult patient after chemotherapy (Escherichia coli L-asparaginase [L-ASP], daunorubicin, vincristine, and intrathecal methotrexate) for acute lymphoblastic leukemia. The development of the PRES was strictly associated with an iatrogenic coagulopathy induced by L-ASP, which inhibits the biosynthesis of hepatic coagulation factors. The nadir of platelet count, antithrombin III (ATIII) and fibrinogen curve was coincident with the onset of the PRES neurological picture; subsequently, the normalization of the ATIII and fibrinogen levels seemed to parallel the good clinical evolution. This case seems to provide new insights into the PRES pathophysiological mechanisms.

Keywords: Coagulopathy; L-asparaginase; chemotherapy; posterior reversible encephalopathy syndrome

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