Reversible posterior encephalopathy syndrome in a 10-year-old child

Abstract

Introduction: The posterior reversible encephalopathy (PRES) syndrome encompasses a set of clinical-radiological findings associated with severe systemic arterial hypertension. This case report proposes to discuss the identification, diagnosis, and management of PRES in the pediatric population. Case presentation: Female patient, 10 years old, admitted to the emergency room with complaint of oliguria and generalized edema. At the initial physical exam, the only alteration present was anasarca. The diagnostic investigation revealed nephrotic syndrome, and clinical treatment was started. She evolved on the 8th day of hospitalization with peak hypertension, sudden visual loss, reduced level of consciousness, nystagmus, and focal seizures requiring intubation. She was transferred to the Intensive Care Unit, with neurological improvement, after the established therapy. CT scan revealed a discrete hypodense area in the white matter of the occipital lobe and anteroposterior groove asymmetry, compatible with PRES. Discussion: PRES is due to vasogenic cerebral edema of acute or subacute installation. Symptoms include headache and altered consciousness, stupor, coma, neurological deficits, seizures and cortical blindness. Nephropathies are the main cause of PRES in pediatrics. Magnetic resonance imaging with diffusion of molecules is the gold standard for diagnosis. The initial treatment objectives are the reduction of blood pressure, antiepileptic therapy, correction of hydroelectrolytic and acid-base disorders and management of intracranial hypertension. Conclusion: PRES is associated with acute hypertension. Early diagnosis and proper management may determine a better prognosis and minimize the severity of the clinical course.

Hemorrhagic Posterior Reversible Encephalopathy Syndrome in a Pediatric Patient With Acute Lymphoblastic Leukemia: A Case Report

“…Therefore, according to this theory, there needs to be a sudden elevation in systemic blood pressure for PRES to occur. The second theory suggests that cytotoxic drugs, including chemotherapy agents used in our case report, can induce PRES through direct cytotoxic effects on the cerebrovascular endothelium, leading to the breakdown of the blood-brain barrier and vasogenic edema [5][6][7][8][9]. Our patient developed PRES, likely due to a combination of factors, including significant hypertension and exposure to induction chemotherapy.…”

Steroid Sensitive Nephrotic Syndrome Presented as Posterior Reversible Encephalopathy Syndrome - A Rare Case Report

“…2 It can also result from the failure of the cerebrovascular auto-regulation mechanisms due to sudden elevations in blood pressure and secondary hypertension in children is commonly related to renal changes, suggesting that these are the main etiologies of PRES. 8 Ishikura et al showed that PRES may occur during moderate to severe nephrotic state in most of the paediatric patients. 4 Several additive factors predispose to the development of PRES in these patients, namely low serum albumin level, generalised edema, increase in vascular permeability, unstable fluid status and renal insufficiency along with child receiving immunosuppressive drugs like cyclosporin.…”