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Abstract(s)
Introdução: A síndrome de encefalopatia posterior reversível, anteriormente conhecida como
leucoencefalopatia posterior reversível, é uma entidade clinico-radiológica do foro
neurológico, descrita inicialmente em adultos e cada vez mais diagnosticada em crianças.
Clinicamente manifesta-se através de cefaleias, alterações visuais, actividade convulsiva,
náuseas, vómitos, comprometimento da consciência e alterações cognitivas.
Radiologicamente, pesquisa-se através da tomografia computadorizada e, sobretudo, da
ressonância magnética, considerada o exame gold-standard, que evidenciam edema cerebral
de carácter vasogénico. Esta síndrome tem sido descrita maioritariamente em pacientes com
eclâmpsia, sépsis, encefalopatia hipertensiva e pacientes que recebem terapia
imunossupressora e/ou quimioterápica. A sintomatologia e as alterações radiológicas são
normalmente reversíveis, quando corrigida atempadamente a causa subjacente, caso
contrário podem resultar em sequelas permanentes, como, cegueira cortical; coma ou morte.
Objectivos: Foram propostos dois objectivos distintos. Caracterizar de forma geral a
síndrome de encefalopatia posterior reversível e investigar qual os principais fármacos
responsáveis por induzirem a síndrome.
Método: A pesquisa foi dividida em duas categorias relacionadas com os distintos objectivos.
Foram pesquisadas publicações indexadas nas bases de dados Pubmed, Elsevier, Wiley e B-On,
na biblioteca electrónica da Faculdade de Ciências da Saúde da Universidade da Beira
Interior. Utilizaram-se os seguintes termos no título: posterior reversible encephalopathy ou
leukoencephalopathy, para a realização do primeiro objectivo e para o segundo acrescentouse
o nome do fármaco em estudo às palavras mencionadas. Foram selecionados trinta e sete e
cento e oito publicações para análise, para o primeiro e segundo objectivos,
respectivamente.
Conclusão: Considera-se que a etiologia primária da encefalopatia posterior reversível seja a
neurotoxicidade farmacológica. Dentro dos fármacos, os quimioterápicos e os
imunomoduladores/imunossupressores representam as classes farmacológicas mais associadas
à síndrome. Através desta investigação, concluiu-se que os fármacos que apresentaram mais
case reports foram, relativamente aos imunossupressores, a ciclosporina (vinte casos),
bevacizumab (dezassete casos) e o tacrolimus (quinze casos) e, relativamente à
quimioterapia, a cisplatina (nove casos), a oxiplatina (nove casos) e a gemcitabina (nove
casos).
Introduction: Posterior reversible encephalopathy syndrome, previously known as posterior reversible leukoencephalopathy syndrome, is a clinical-radiological entity, initially described in adults and increasingly diagnosed in children. Clinically it is presented with headaches, visual disturbances, seizure activity, nausea, vomiting, impaired consciousness and cognitive alterations. Neuroimaging findings, through computed tomography and especially magnetic resonance studies, which is the gold-standard diagnostic procedure, demonstrate vasogenic edema in various brain areas. This syndrome has been described mostly in patients with eclampsia, sepsis, hypertensive encephalopathy and patients receiving immunosuppressives and/or chemotherapy. The symptoms and radiographic alterations are usually reversible when the underlying cause is corrected promptly, otherwise they can result in permanent sequelae, such as, cortical blindness; coma or death. Objectives: Two distinct objectives were proposed. First, briefly describe posterior reversible encephalopathy syndrome and, secondly, investigate what medications are most frequently associated with the syndrome. Method: The research was divided into two categories associated to the distinct objectives. Indexed publications were searched in Pubmed, Elsevier, Wiley and B-On on the electronic library of the Faculty of Ciências da Saúde, University of Beira Interior. The following terms were searched in the title: posterior reversible encephalopathy or leukoencephalopathy. One hundred and forty six articles were examined. Conclusion: It is considered that the primary cause of reversible encephalopathy is pharmacological-related neurotoxicity. Chemotherapy and immunotherapy drugs represent the classes primarily associated with the syndrome. After this research, it was discovered that the drugs mention in most case reports, were cyclosporin (twenty cases), bevacizumab (seventeen cases) and tacrolimus (fifteen cases), accounting for immunotherapy, and cisplatin (nine cases), oxiplatin (nine cases) and gemcitabine (nine cases), accounting for chemotherapy.
Introduction: Posterior reversible encephalopathy syndrome, previously known as posterior reversible leukoencephalopathy syndrome, is a clinical-radiological entity, initially described in adults and increasingly diagnosed in children. Clinically it is presented with headaches, visual disturbances, seizure activity, nausea, vomiting, impaired consciousness and cognitive alterations. Neuroimaging findings, through computed tomography and especially magnetic resonance studies, which is the gold-standard diagnostic procedure, demonstrate vasogenic edema in various brain areas. This syndrome has been described mostly in patients with eclampsia, sepsis, hypertensive encephalopathy and patients receiving immunosuppressives and/or chemotherapy. The symptoms and radiographic alterations are usually reversible when the underlying cause is corrected promptly, otherwise they can result in permanent sequelae, such as, cortical blindness; coma or death. Objectives: Two distinct objectives were proposed. First, briefly describe posterior reversible encephalopathy syndrome and, secondly, investigate what medications are most frequently associated with the syndrome. Method: The research was divided into two categories associated to the distinct objectives. Indexed publications were searched in Pubmed, Elsevier, Wiley and B-On on the electronic library of the Faculty of Ciências da Saúde, University of Beira Interior. The following terms were searched in the title: posterior reversible encephalopathy or leukoencephalopathy. One hundred and forty six articles were examined. Conclusion: It is considered that the primary cause of reversible encephalopathy is pharmacological-related neurotoxicity. Chemotherapy and immunotherapy drugs represent the classes primarily associated with the syndrome. After this research, it was discovered that the drugs mention in most case reports, were cyclosporin (twenty cases), bevacizumab (seventeen cases) and tacrolimus (fifteen cases), accounting for immunotherapy, and cisplatin (nine cases), oxiplatin (nine cases) and gemcitabine (nine cases), accounting for chemotherapy.
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Keywords
Encefalopatia Posterior Reversível Imunossupressores Neurotoxicidade Quimioterapia