Sotto PRESsione

Posterior Reversible Encephalopathy Syndrome (PRES) is an acute neurological entity characterized by headache, confusion, visual disturbances, seizures, and predominantly parieto-occipital cortico-subcortical oedema, with a generally favourable course resolving within approximately two weeks. We report the case of a 16-year-old female with ALK+ anaplastic large T-cell lymphoma (ALCL 99 high-risk protocol) who developed severe headache, hypertension, and seizures during the first AM1 cycle with intravenous methotrexate and ifosfamide. While the brain CT scan was negative, brain MRI revealed alterations consistent with PRES. Chemotherapy was suspended and treatment with midazolam, levetiracetam, and antihypertensive agents was initiated, leading to rapid clinical improvement and blood pressure normalization. This case highlights the importance of timely recognition of PRES related to cytotoxic agents, steroids, and hypertension, as well as its favourable prognosis, which allows for the safe resumption of oncological treatment.