Neuropathology of a fatal case of posterior reversible encephalopathy syndrome. Pediatr Dev Pathol 2010;13(5):397-403
Date
02/18/2010Pubmed ID
20158377DOI
10.2350/09-04-0634-CR.1Scopus ID
2-s2.0-79952197856 (requires institutional sign-in at Scopus site) 23 CitationsAbstract
The pathology of posterior reversible encephalopathy syndrome (PRES) is undefined, since it is rarely fatal and is biopsied in only exceptional circumstances. We describe rapidly progressive PRES following stem cell transplant for acute lymphoblastic leukemia. After development of altered mental status, this 8-year-old girl had T2 prolongation of the white matter in a posterior-dominant distribution, eventually developing cerebellar edema, hemorrhage, hydrocephalus, and herniation. Despite surgical and medical management, she died 36 hours later. At autopsy, the occipital and cerebellar white matter and focal occipital cortical gray matter showed a spectrum of microvascular changes, including dilated perivascular spaces containing proteinaceous exudates and macrophages, as well as fibrinoid necrosis and acute hemorrhage, in a distribution corresponding to the neuroimaging abnormalities and reminiscent of those seen in patients with acute hypertensive encephalopathy. Of note, similar microvascular changes were not seen in the kidney or other systemic sites. Thus, the findings indicate a brain-specific microvascular compromise as the substrate of PRES, at least in the rare instance of cases progressing to fatal outcome.
Author List
Kheir JN, Lawlor MW, Ahn ES, Lehmann L, Riviello JJ, Silvera VM, McManus M, Folkerth RDAuthor
Michael W. Lawlor PhD, MD Adjunct Professor in the Pathology and Laboratory Medicine department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
Brain DiseasesBrain Edema
Child
Cord Blood Stem Cell Transplantation
Fatal Outcome
Female
Humans
Precursor Cell Lymphoblastic Leukemia-Lymphoma
