背景:霍奇金淋巴瘤,淋巴系统癌症,通过化疗治疗,放射治疗,和造血干细胞移植。后部可逆性脑病综合征(PRES)是一种罕见的神经毒性作用,与几种药物和全身性疾病有关。该案例研究强调了强化化疗方案的潜在风险,并假设Willis变异环对PRES半球病变异质性的影响。
方法:一名42岁女性被诊断为IIA期结节性硬化性霍奇金淋巴瘤和慢性血小板减少症,在最初诊断6年和单倍体移植后4年后出现。她接受了计划中的异环磷酰胺化疗,卡铂,和依托泊苷。
方法:她的精神状态发生了改变。头颈部的计算机断层扫描扫描和血管造影显示,发现与PRES和左胎型大脑后动脉一致,左脑前动脉的再生障碍性A1段。一小时后,她被发现昏迷,并伴有无核疝的临床后遗症。
方法:随后的事件导致紧急插管,服用23.4%的高渗盐水。重复的计算机断层扫描显示右侧实质内出血,液体水平高达4.7厘米,双侧蛛网膜下腔出血,右耳疝,向左中线偏移15毫米。她紧急接受了右半开颅减压术。
结果:脑部磁共振成像显示双侧细胞毒性水肿累及顶枕叶。尽管采取了干预措施,病人的神经状况恶化,导致在第8天宣布脑死亡。
结论:这个案例强调了认识到严重神经系统并发症的重要性,包括PRES,与霍奇金淋巴瘤的化疗治疗有关。在这种情况下,PRES也可能因凝血病如血小板减少而加剧。Willis变异环可能会影响脑血流,自动调节,和其他血液动力学因素,导致对放射学病变负担和最差临床结局的易感性增加。
BACKGROUND: Hodgkin lymphoma, a lymphatic system cancer, is treated by chemotherapy, radiation therapy, and hematopoietic stem cell transplantation. Posterior reversible encephalopathy syndrome (PRES) is a rare neurotoxic effect associated with several drugs and systemic conditions. This
case study emphasizes the potential risks of intensive chemotherapy regimens and postulates the impact of the circle of Willis variants on the heterogeneity of hemispheric lesions in PRES.
METHODS: A 42-year-old woman diagnosed with stage IIA nodular sclerosing Hodgkin lymphoma and chronic thrombocytopenia presented after 6 years of initial diagnosis and 4 years post-haploidentical transplant. She underwent planned chemotherapy with ifosfamide, carboplatin, and etoposide.
METHODS: She developed an alteration in her mental status. A computerized tomography scan and angiogram of the head and neck revealed findings consistent with PRES and a left fetal-type posterior cerebral artery with an aplastic A1 segment of the left anterior cerebral artery. One hour later she was found comatose with clinical sequelae of an uncal herniation.
METHODS: Subsequent events led to emergent intubation, and administration of 23.4% hypertonic saline. A repeat computerized tomography scan showed a right intraparenchymal hemorrhage with fluid-fluid levels measuring up to 4.7 cm, bilateral subarachnoid hemorrhage, right uncal herniation, and 15 mm of leftward midline shift. She emergently underwent a right decompressive hemi-craniectomy.
RESULTS: An magnetic resonance imaging of the brain demonstrated bilateral cytotoxic edema involving the parieto-occipital lobes. Despite interventions, the patient\'s neurological condition deteriorated, leading to a declaration of brain death on the 8th day.
CONCLUSIONS: This
case underscores the importance of recognizing the severe neurological complications, including PRES, associated with chemotherapeutic treatments in Hodgkin lymphoma. PRES may also be exacerbated by coagulopathies such as thrombocytopenia in this
case. The circle of Willis variants may influence cerebral blood flow, autoregulation, and other factors of hemodynamics, leading to increased susceptibility to both radiographic lesion burden and the worst clinical outcomes.