Posterior Reversible Encephalopathy Syndrome in Children:: A Prospective Follow-up Study

Abstract

Aim: To evaluate clinical and radiologic presentation, and neurologic outcome of pediatric posterior reversible encephalopathy syndrome (PRES). Patients and Methods: The study included 24 children (14 males and 10 females) diagnosed with PRES who were prospectively followed for 2 years. They were evaluated using Wechsler Intelligence Scale, electroencephalograph (EEG), and brain magnetic resonance imaging (MRI). Results: The mean age of the studied patients at the time of diagnosis of PRES was 6 years (±2.2). Chemotherapy for cancer represented 66.7% of the causes of PRES in the studied children, followed by renal disorders and immunosuppressive agents for hematopoietic stem cell transplantation. Twenty-seven attacks of PRES were reported as 3 children developed a second attack of PRES. Normal intelligence quotient was found in 95.8% of studied children after PRES. Residual abnormalities in follow-up MRI were demonstrated in 3 children. Epilepsy and residual MRI lesions were reported in 2 of the 3 children with recurrent PRES. Residual lesions in follow-up MRI and epilepsy were more significantly reported after recurrent PRES ( P < .05). Conclusions: Neoplastic, renal disorders and hematopoietic stem cell transplantation represent the main disorders associated with PRES in children. Chemotherapeutic drugs, immunosuppressants, and hypertension are the main risk factors for pediatric PRES. The outcome of pediatric PRES is good, but long-term neurologic sequelae can occur, mainly epilepsy and residual MRI abnormalities. Recurrence of PRES is infrequently reported in children receiving chemotherapeutic or immunosuppressive drugs. Recurrent PRES is a risk factor for long-term neurologic sequelae.

Analysis of Risk Factors Associated With Poor Outcome in Posterior Reversible Encephalopathy Syndrome After Treatment in Children: Systematic Review and Meta-Analysis

“…However, in a 2018 study published by Li et al (25), in a total of 84 children with the thalassemia after conducting HSCT, 62 patients were male, and of the 11 PRES patients, 5 patients (45.4%) were male. In 2017, a study reported by Gaziev et al (18) showed that in children with hematological diseases after HSCT, the male-to-female ratio was 23:8, and in pediatric cancers treated with chemotherapy, the male-to-female ratio was 14 (58%):10 (41.7%) among 24 pediatric patients with PRES (7). In contrast, a case-control study composed of acute lymphoblastic leukemia (ALL) pediatric patients that also underwent chemotherapy concluded that maleto-female ratio was 25 (48%):27 (51%), and the age group 10.0-17.0 years, or older children were prone to developing PRES (2).…”

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

“…The patients did not have any other PRES attacks during the follow-up period. Development of epilepsy as a sequela was observed in other studies: Datar et al, 16 2.4%; Sha et al, 18 2.6%; Heo et al, 19 3.9%; Darwish et al, 26 8;3%; Endo et al, 15 25%. The longest median follow-up in these studies was 3.2 years.…”

Posterior reversible encephalopathy syndrome associated with mild COVID-19 infection in a 9-year-old child: A case report and literature review

“…In the pediatric age group, neoplastic, renal disorders and hematopoietic stem cell transplantation represent the main disorders associated with PRES [11] . Chemotherapeutic drugs, immunosuppressants, and hypertension appear to be the main risk factors for the development of pediatric PRES [11] . A retrospective study has suggested no association between sepsis and PRES in children [12] .…”