MGMT Methylation Is a Prognostic Biomarker in Elderly Patients With Newly Diagnosed Glioblastoma

Posterior reversible encephalopathy syndrome (PRES) is a reversible syndrome that presents with nausea and headache; altered consciousness; weakness; visual changes, including blurred vision or hemianopsia; seizures; and rarely coma. 1 MRI demonstrates vasogenic edema, generally bilateral, predominant in the posterior parietal, temporal, and occipital regions of the brain. Commonly associated with severe acute hypertension, PRES is associated with eclampsia, renal failure, electrolyte disorders, hypocholesterolemia, drug abuse, infections, autoimmune diseases, and immunosuppressive and chemotherapy. se report. A 39-year-old woman with untreated hypertension was admitted with headache, nausea, and vomiting. Three months before admission she had received radiation therapy for a single metastatic lesion in the odontoid process of a peritoneal leiomyosarcoma; 20 days before, she had completed a chemotherapy cycle with gemcitabine. She was drowsy with blurred vision. Blood pressure was 220/120 mm Hg and examination of optic fundus disclosed signs of hypertensive retinopathy. The examination was otherwise unremarkable, with flexor plantar responses. Blood tests were normal. Spectral attenuated inversion recovery MRI sequences showed large, confluent, bilateral, mostly symmetric hyperintense regions in the white matter of parietal and occipital lobes, cerebellar hemispheres, and right frontal lobe (fig- Diffusion-weighted images demonstrated corresponding regions of increased water diffusivity; mild contrast enhancement was observed. MRI of the cervical spinal cord revealed a diffuse, central hyperintense signal on TSE T2-weighted sequences and mild swelling of the spinal cord; contrast enhancement was absent (figure, A). A diagnosis of PRES with spinal cord involvement was made.