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Posterior reversible encephalopathy syndrome in children: a case series
Serhat Emeksiz1, Nurettin Onur Kutlu1, Hüseyin Çaksen2
1Department of Pediatric Intensive Care, Necmettin Erbakan University Meram School of Medicine, Konya, Turkey.
Insights
Posterior reversible encephalopathy syndrome (PRES) can occur in children with underlying conditions like leukemia or lupus. Prompt diagnosis and treatment lead to complete recovery in all cases.
Area of Science:
- Neurology
- Pediatrics
- Radiology
Background:
- Posterior reversible encephalopathy syndrome (PRES) is a neurological condition often associated with hypertension, seizures, and altered consciousness.
- Diagnosis typically relies on characteristic magnetic resonance imaging (MRI) findings.
Observation:
- A retrospective study reviewed five pediatric patients diagnosed with PRES between 2010 and 2014.
- Underlying conditions included acute lymphocytic leukemia, Henoch-Schönlein purpura, systemic lupus erythematosus, and poststreptococcal glomerulonephritis.
- All patients presented with acute hypertension and neurological symptoms like seizures, headache, and visual disturbances.
Findings:
- All five patients exhibited acute hypertension.
- Neurological manifestations included seizures, clouded consciousness, headache, and visual disturbances.
- Complete clinical recovery was achieved in all patients following appropriate therapeutic interventions.
Implications:
- PRES should be considered in the differential diagnosis of pediatric encephalopathy, especially in patients with hypertension and conditions like nephritis, vasculitis, or malignancy.
- Early recognition and management are crucial for favorable outcomes in pediatric PRES.
- This study highlights the importance of neuroimaging and clinical correlation for diagnosing PRES in children.
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.
