Long-Term Follow-Up of Patients with a Diagnosis of Posterior Reversible Encephalopathy Syndrome

Abstract

Objective: The essential characteristics of posterior reversible encephalopathy syndrome ( PRES) are the presence of acute onset neurologic symptoms, focal vasogenic edema at neuroimaging, and reversible clinical and/or radiologic findings. This study aimed to evaluate the clinical findings, causes, radiologic findings, and prognoses of patients with PRES. Methods: Patients with PRES confirmed with clinical and radiologic findings by a pediatric neurologist were evaluated retrospectively. Results: Seventeen patients with PRES were evaluated (mean age at onset, 10.23 ± 4.65 years; range, 2-17 years; girls, 29.4% [n = 5]). The mean length of follow-up was 6 ± 2.3 years (range, 3.4-10 years). Mortality due to primary disease occurred in 4 patients (23.5%) during follow-up. PRES was derived from renal diseases in 10 patients (58.8%), hematologic diseases in 6 patients (35.3%), and liver disease in one patient (5.9%). Hypertension was present in 16 patients (94.1%) at onset of PRES (>99th percentile). Seizure, the most frequent initial symptom, was observed in 82.4% (n = 14). Blurred vision and headache were the initial symptoms in 3 patients (17.6%). Sequelae were observed at magnetic resonance imaging (MRI) in 6 patients. Development of epilepsy was determined as a sequela in 4 patients (23.5%) and mental motor retardation in 2 patients (11.8%). Conclusion: Epilepsy is uncommon in patients who have recovered from PRES. The presence of gliosis on MRI and interictal epileptic discharges on electroencephalograms are major risk factors for the development of epilepsy. Antiepileptic treatment can be stopped in the early period in patients with normal MRI and electroencephalogram by eliminating the factors that trigger the seizures.

Periodic Lateralized Epileptiform Discharges: A Child with a Rare Manifestation of Posterior Reversible Encephalopathy Syndrome and Literature Review

“… 1 The underlying cause of PRES typically arises from endothelial dysfunction triggered by factors such as fluctuating blood pressure, acute renal failure, drug toxicity, immunosuppressive agents, electrolyte imbalances, infections, and autoimmune disorders. 1 , 2 Electroencephalography (EEG) plays a crucial role in evaluating encephalopathy and identifying nonconvulsive status epilepticus in patients with PRES. 3 However, definitive EEG findings specific to PRES have not been established.…”