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Posterior reversible encephalopathy syndrome in a child with bronchial asthma

Hirokazu Kurahashi1, Akihisa Okumura, Teruko Koide

  • 1Department of Pediatrics, Nagoya University Graduate School of Medicine, Aichi, Japan. hiro-k@med.nagoya-u.ac.jp

Brain & Development
|April 18, 2006
PubMed

Insights

Posterior reversible encephalopathy syndrome (PRES) is a rare adverse event linked to steroid treatment for severe asthma. This case highlights the importance of monitoring for PRES in pediatric patients receiving corticosteroids.

Area of Science:

  • Neurology
  • Pediatrics
  • Pulmonology

Background:

  • Posterior reversible encephalopathy syndrome (PRES) is a neurological condition associated with various underlying causes.
  • Bronchial asthma management often involves corticosteroid therapy, a known risk factor for PRES.
  • No prior reports have documented PRES specifically in association with bronchial asthma.

Observation:

  • A 4-year-old girl with severe asthmatic attack received corticosteroid treatment.
  • She developed hypertension, pulmonary edema, and cardiomegaly, followed by lethargy and generalized convulsions.
  • Neuroimaging revealed characteristic PRES findings in the bilateral occipital white matter.

Findings:

  • The patient presented with clinical and radiological evidence of PRES during corticosteroid therapy for asthma.
  • Discontinuation of corticosteroids and antihypertensive management led to clinical improvement.
  • Follow-up imaging showed complete resolution of PRES, with no neurological sequelae observed at two years.

Implications:

  • This case underscores that PRES is a rare but significant adverse event associated with corticosteroid therapy.
  • Physicians should maintain a high index of suspicion for PRES in pediatric patients with asthma receiving steroids, especially if hypertension or neurological symptoms arise.
  • Awareness of steroid-induced hypertension and water retention is crucial for early PRES detection and management.

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