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Unilateral Transient Watershed Cerebral Infarct in a 6-Year-Old Girl with Frequently Relapsing Nephrotic Syndrome
Kapil Bhalla1, Deepali Garg1, Mahima Rajan1
1Department of Pediatrics, Pt B D Sharma Postgraduate Institute of Medical Sciences, Rohtak, Haryana, India.
Journal of Natural Science, Biology, and Medicine
|February 20, 2018
Summary
Nephrotic syndrome can cause strokes in children. A case study shows a unilateral watershed infarct, possibly linked to posterior reversible encephalopathy syndrome, resolved with steroid treatment.
Area of Science:
- Neurology
- Pediatrics
- Nephrology
Background:
- Nephrotic syndrome is a known prothrombotic state, increasing risks for venous sinus thrombosis and arterial stroke.
- Watershed infarcts, typically bilateral, occur in hypotensive hypovolemic states at the junction of arterial territories.
Observation:
- A 6-year-old girl with frequently relapsing nephrotic syndrome presented with sudden hemiparesis and aphasia.
- Brain MRI revealed a unilateral watershed infarct in a border zone between major cerebral arteries.
- MR angiography showed normal vessel anatomy, with restricted diffusion indicating acute infarct.
Findings:
- The unilateral watershed infarct in this patient suggests an atypical presentation.
- The findings were consistent with an asymmetric variant of posterior reversible encephalopathy syndrome (PRES).
Implications:
- This case highlights a potential, less common neurological complication of nephrotic syndrome in children.
- Prompt diagnosis and treatment, including steroid remission, may lead to favorable neurological outcomes.
- Further research into the neurovascular complications of nephrotic syndrome is warranted.
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