Posterior Reversible Encephalopathy Syndrome in Children

Abstract

To study presentations and outcome of posterior reversible encephalopathy syndrome in children, we retrospectively analyzed 14 patients admitted to our pediatric intensive care unit. We further assessed 94 additional pediatric cases from a systematic review. Our patients had a mean age of 11.6 years. Their precipitating factors were hypertension (100%), immunosuppressants (71%), antineoplastic agents (21%), and hemodialysis (14%). Initial neurologic manifestations included seizures (100%), mental change (100%), headache (79%), and visual disturbance (57%). After prompt diagnosis by magnetic resonance imaging (MRI) with intensive management, all patients had complete clinical recovery with subsequent radiologic resolution. Systemic literature review indicated that seizures (90%), hypertension (85%), and atypical neuroimaging findings (80%) are common presentations in childhood posterior reversible encephalopathy syndrome. We conclude that in children presenting with seizures and hypertension, a pediatric neurologist should consider posterior reversible encephalopathy syndrome within a comprehensive differential diagnosis of acute encephalopathy. Early recognition and intensive care are essential to ensure complete neurologic recovery in children with posterior reversible encephalopathy syndrome.

Posterior Reversible Encephalopathy Syndrome in Two Omani Children with Underlying Renal Diseases

“…12,13 Seizures are a common and frequently encountered symptom of PRES, among a wide range of other neurological symptoms. 5 In the first case presented in the current report, the patient had multiple risk factors that contributed to the onset of PRES. These included lupus nephritis confirmed by renal biopsy, the use of methylprednisone for disease control and extremely high BP.…”

“…The most common risk factor is a hypertensive crisis. 5 Therefore, any condition that predisposes to hypertension can lead to the development of PRES. This includes many renal conditions affecting the glomerulus, such as lupus nephritis; 6,7 the renal vessels, such as renal artery stenosis; 8 and those conditions with renal anatomical defects such as grade four vesicoureteral reflux.…”

Posterior reversible encephalopathy syndrome: Some novel associations

“…There is a predilection for involvement of posterior circulation territories, thought to result from the relatively sparse sympathetic innervations of the vertebrobasilar circulation, but there are reports of involvement of the anterior brain, brainstem, basal ganglia, corpus callosum and cerebellum (atypical magnetic resonance imaging (MRI) findings). [1,6] The second postulated cause for PRES is a direct cytotoxic effect on the cerebrovasular endothelium. [6] We report these cases to highlight some unusual associations with this condition.…”

“…[1,6] The second postulated cause for PRES is a direct cytotoxic effect on the cerebrovasular endothelium. [6] We report these cases to highlight some unusual associations with this condition. The first two cases are unique as the patients had PRES following hypoxic encephalopathy.…”

“…Since then, a few case reports and some case series have been published. [3][4][5][6] The most frequently implicated cause of PRES is a hypertensive crisis. Renal failure, fluid retention, and some immunosuppressive drugs have also been reported as causes.…”