Children with posterior reversible encephalopathy syndrome associated with atypical diffusion-weighted imaging and...

Area of Science:

• Neurology
• Pediatric Nephrology
• Radiology

Background:

• Posterior reversible encephalopathy syndrome (PRES) is a neurological condition characterized by reversible leukoencephalopathy, often associated with hypertension, renal insufficiency, or immunosuppressants.
• PRES typically affects the posterior brain regions and can present with diverse clinical and radiological findings.

Observation:

• Two pediatric cases of PRES secondary to idiopathic nephrotic syndrome and lupus nephritis were analyzed.
• Cranial magnetic resonance (MR) imaging revealed strong hyperintense signals on diffusion-weighted imaging (DWI) with restricted apparent diffusion coefficient (ADC) values, predominantly in posterior brain regions.

Findings:

• The observed MR imaging findings, particularly restricted diffusion, are rarely reported in pediatric PRES and initially suggested irreversible brain damage.
• Despite initial imaging concerns, both children achieved complete clinical and radiological recovery.
• This suggests that DWI/ADC findings in PRES may not always correlate with irreversible injury.

Implications:

• Cranial MR imaging, including DWI with ADC mapping, has limitations in accurately diagnosing early-stage PRES and predicting patient outcomes.
• Further research and experience are needed to refine the diagnostic accuracy and prognostic value of advanced MR techniques in pediatric PRES.
• Clinicians should consider the potential for reversible changes in PRES, even with concerning initial imaging findings.