Reversible Posterior Leukoencephalopathy Syndrome in Cancer

Reversible posterior leukoencephalopathy syndrome (RPLS) is a subacute neurological syndrome typically manifesting with headache, cortical blindness, and seizures. The syndrome is associated with risk factors such as malignant hypertension, eclampsia, and renal failure. Numerous case reports depict its occurrence in cancer patients. The direct causal relationship for the mechanism of RPLS in cancer patients has not yet been defined. Cytotoxic chemotherapy may cause direct endothelium damage, which would impact the blood-brain barrier. Chemotherapies also cause elevations in blood pressure; this is significant because RPLS onset may be solely related to hypertension. An increased number of case reports involving new targeted agents suggests that RPLS incidence may increase in the future. Agents such as bevacizumab and sorafenib have been implicated in new cases of RPLS.