Posterior reversible encephalopathy syndrome in children: a case series

Abstract

Posterior reversible encephalopathy syndrome is characterized by hypertension, seizure, headache, clouding of consciousness, and visual disturbance, and is diagnosed in the presence of typical lesions on magnetic resonance imaging. We retrospectively evaluated five patients who were diagnosed as having posterior reversible encephalopathy syndrome and followed up in Meram Medical Faculty, Pediatric Intensive Care and Hematology wards, between January 2010 and January 2014. We reviewed the demographic and clinical data, and neuroimaging findings. The primary diseases of the subjects included acute lymphocytic leukemia (n=2), Henoch-Schönlein purpura (n=1), systemic lupus erythematous (n=1), and acute poststreptococcal glomerulonephritis (n=1). The mean age was 10±4.58 years (range, 5-14 years). Acute elevation of blood pressure was found in all patients (n=5). Initial neurologic manifestations included seizure, clouding of consciousness, headache, and visual disturbance. After the diagnosis was made through clinical evaluations and magnetic resonance imaging, complete clinical recovery was obtained in all patients with the appropriate therapeutic approach. In conclusion, posterior reversible encephalopathy syndrome should be considered in the differential diagnosis of patients who present with encephalopathy and underlying diseases such as nephritis, vasculitis, malignancy accompanied by hypertension, and a history of use of medication.

Posterior reversible encephalopathy syndrome in IgA vasculitis: Neuroimaging of a 14-year-old child

“…However, it was difficult to establish the exact cause of PRES in our case, because of positive fundus examination, absence of convulsion or focal neurological deficit, presence of proteinuria and impaired renal functions, the vasogenic pattern of edema and reversible features in neuroimaging by treatment, we determined that our findings as consistent with hypertension. Diagnosis and differentiation of PRES and secondary cerebral vasculitis in IgAV, said to be difficult due to collective attribution of hypertensive or uremic encephalopathy, metabolic disorders, electrolyte imbalance, impairment in auto-regulatory mechanism of cerebral circulation or side effects of steroid therapy [5,10,12,15]. To rule out possible cerebral vasculitis, we did not perform magnetic resonance angiography due to rapid clinical improvement after treatment.…”

Challenges of Diagnosing Pediatric Posterior Reversible Encephalopathy Syndrome in Resource Poor Settings: A Narrative Review

“…54 Stroke mimic not recognized as PRES leads to incorrect diagnostic pathway with potential for iatrogenic harm through improper administration of thrombolytic therapy. 66 When compared to the high income countries also, poverty and poor clinical settings in LMIC contributes to the diagnostic challenges and may contribute to limited research interest in pediatric PRES with consequent underreporting of PRES [67][68][69] Most of the reports of pediatric PRES have been from developed countries 2,4,[10][11][12][13][14][15][16][17][18][19][20][21] and a few from Africa. Nandi and colleagues 70 in South Africa were able to diagnose PRES in 4 children with novel aetiological associations: hypoxia following accidental strangulation, near-drowning episode, a child with thalassaemia receiving routine blood transfusions, and a fourth child who had PRES while recovering from toxic epidermal necrolysis syndrome (TENS).…”

“…61 Patients with posterior reversible encephalopathy syndrome may need to be managed in the setting of intensive care units (ICU) since status epilepticus, coma, respiratory failure, or hypertensive crisis may develop and require prompt interventions. 18,62 Treatment of hypertension is a mainstay management and seizures when present, can be controlled with antiepileptic drugs, though no specific published guidelines were seen as specific protocols for prescribing antiepileptics or antihypertensive drugs in PRES management. 27 If PRES is precipitated by a specific medication, the offending medication should be discontinued, be it temporarily.…”

“…Most of the cases of PRES observed in pediatric patients have been reported from developed countries. 2 , 4 , 10 - 21 This may be due to a range of factors that includes the lack of ready infrastructure such as MRI, to make eventual diagnosis. However, most of the risk factors of PRES in children such as severe sepsis, are very common in developing countries, including Nigeria.…”

Primary Hyperparathyroidism Presenting as Posterior Reversible Encephalopathy Syndrome: A Report of Two Cases

“…PHPT per se is an uncommon endocrine disease in the pediatric population with a prevalence of 2-3 cases per 100,000 (19). Similarly, PRES in the pediatric/adolescent population is relatively uncommon with mostly anecdotal case reports and few small case series (20,21). No case of PRES in young PHPT has hitherto been reported.…”