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Posterior Reversible Encephalopathy Syndrome: A Comparative Study of Pediatric Versus Adult Patients
Kenneth Habetz1, Raghu Ramakrishnaiah2, Sunil Kumar Raina3
1Department of Pediatric Neurology, Arkansas Children Hospital, Little Rock, Arkansas.
Insights
Posterior reversible encephalopathy syndrome (PRES) in children is more frequently associated with multi-organ failure, temporal lobe involvement, and restricted diffusion compared to adults. These factors highlight key differences in pediatric PRES presentation and imaging findings.
Area of Science:
- Neurology
- Radiology
- Pediatrics
Background:
- Posterior reversible encephalopathy syndrome (PRES) is an acute, typically reversible neurotoxic condition.
- While reversible, PRES can lead to significant long-term neurological deficits.
- Understanding age-specific factors in PRES is crucial for timely diagnosis and management.
Purpose of the Study:
- To identify clinical and radiological factors unique to pediatric Posterior reversible encephalopathy syndrome (PRES).
- To compare these unique factors in children versus adults diagnosed with PRES.
- To enhance diagnostic and treatment strategies for PRES across different age groups.
Main Methods:
- Retrospective review of clinical and radiological records of PRES patients from 2007-2014.
- Dichotomization of patients into pediatric ( < 18 years) and adult ( ≥ 18 years) groups.
- Comparative analysis of baseline variables, clinical, laboratory, and imaging features between groups.
Main Results:
- Pediatric PRES (19 patients) showed significantly higher rates of multi-organ failure (84.2% vs 50%) and temporal lobe involvement (63.3% vs 39%) compared to adults (100 patients).
- Restricted diffusion on imaging was more common in pediatric PRES (42.1% vs 18%).
- Cerebellar involvement was less frequent in children (21.1% vs 57%).
Conclusions:
- Multi-organ failure, temporal lobe involvement, and restricted diffusion are key distinguishing features of PRES in children compared to adults.
- These findings underscore the distinct pathophysiology and clinical presentation of pediatric PRES.
- Highlighting these unique factors can improve early recognition and management of PRES in pediatric populations.
Background:
Posterior reversible encephalopathy syndrome (PRES) is an acute neurotoxic syndrome that, although characteristically reversible, can result in long-term disability. Our aim was to identify the clinical and radiological factors that are unique to children with PRES compared with adults with the syndrome in a single center.
Methods:
We retrospectively reviewed the clinical and radiological records of all patients with PRES admitted at a tertiary care medical center from 2007 to 2014. All patients who met the clinical and radiological criteria for PRES were dichotomized into children (less than 18 years) and adults (18 years or older) based on their age groups, and comparison of their baseline variables, clinical, laboratory, and imaging features was performed.
Results:
During this study period, 19 pediatric patients and 100 adult patients with PRES were identified. On univariate analysis, factors significantly associated with pediatric patients with the syndrome were multiorgan failure (84.2% vs 50%, P = 0.006), temporal lobe involvement (63.3% vs 39%, P = 0.04), restricted diffusion (42.1% vs 18%, P = 0.02), and less likelihood of cerebellar involvement (21.1% vs 57%, P = 0.004). On bivariate logistic regression analysis, all these factors remained significantly associated with pediatric PRES; multiorgan failure (odds ratio: 5.80, 95% confidence interval: 1.45 to 29.41, P = 0.03), temporal lobe involvement (odds ratio: 5.08, 95% confidence interval: 1.17 to 22.17, P = 0.03), restricted diffusion (odds ratio: 2.48, 95% confidence interval: 1.61 to 10.10, P = 0.02), and less likely to have cerebellar involvement (odds ratio: 0.08, 95% confidence interval: 0.002 to 0.39, P = 0.002).
Conclusions:
Factors unique to PRES in children compared with adults include a greater propensity with multi-organ failure, involvement of the temporal lobe, and restricted diffusion on imaging.
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