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Posterior reversible encephalopathy syndrome revealing renal artery stenosis in a child
Gregoire Benoist1, Claire Dossier, Monique Elmaleh
1Department of Paediatric, Hôpital Ambroise Paré, AP-HP, University of Versailles Saint-Quentin-en-Yvelines, Boulogne, France.
Insights
Hypertension in children with seizures may indicate posterior reversible encephalopathy syndrome (PRES). Early diagnosis via MRI and prompt treatment, like nephrectomy for renal artery stenosis, can lead to full recovery without neurological deficits.
Area of Science:
- Pediatric Neurology
- Nephrology
- Radiology
Background:
- Posterior reversible encephalopathy syndrome (PRES) is a rare neurological condition.
- Hypertension is a common symptom but can be misattributed to seizures.
- Prompt diagnosis and treatment are crucial for favorable outcomes in pediatric PRES.
Abstract:
A 14-year-old girl was admitted to the emergency department for repeated seizures with no fever. High blood pressure at admission was ascribed to the status epilepticus. Seizure recurrence promoted transfer to the paediatric intensive care unit. The MRI visualised bilateral, subcortical, white-matter lesions in the parietal and occipital lobes suggesting posterior reversible encephalopathy syndrome (PRES). Continuous nicardipine infusion corrected the hypertension and neurological manifestations within a few hours. The diagnostic workup showed right renal artery stenosis. Blood pressure returned to normal values for age after right nephrectomy. She was discharged home without treatment. She had no residual neurological impairments. This case highlights the risk of misinterpreting sustained hypertension in children with repeated seizures. We briefly review paediatric PRES, which is rare as compared to adults. Increased awareness among critical care physicians, together with greater availability of cerebral MRI, is decreasing the time to diagnosis.
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