Gemcitabine-associated posterior reversible encephalopathy syndrome: MR imaging and MR spectroscopy findings

A 55 year old female receiving gemcitabine for stage IV non-small cell carc inoma of the lung developed the clinical-radiologic syndrome of posterior r eversible encephalopathy syndrome (PRES). She had clinical manifestations o f headaches, increasing somnolence and tonic-clonic seizures. The fluid-att entuated inversion recovery (FLAIR) MR imaging sequence conspicuously showe d bihemispheric, symmetrical cortical and subcortical white matter hyperint ensities that preponderantly involved the parietal and occipital lobes. Dif fusion-weighted imaging (DWI) sequence reflected the preponderant existence of vasogenic edema in the involved areas. MR spectroscopy showed no signif icant N-acetyl aspartate (NAA) depletion or lactate elevation prospectively , indicating the absence of significant neuronal loss and reversibility of the brain parenchymal changes. The clinical and radiologic manifestations e ssentially resolved completely with discontinuation of the drug. (C) 2001 E lsevier Science Inc. All rights reserved.