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Reversible posterior encephalopathy syndrome in a 10-year-old child
Eve Grillo Carvalho1, Henrique Guarino Colli Peluso1, Lorena Luana Batista1
1Universidade Federal de Viçosa, Departamento de Medicina e Enfermagem (DEM), Viçosa, MG, Brasil.
Insights
Posterior reversible encephalopathy syndrome (PRES) is linked to severe hypertension. Early diagnosis and management, particularly in pediatric nephrotic syndrome cases, are crucial for better outcomes.
Area of Science:
- Neurology
- Pediatrics
- Nephrology
Background:
- Posterior reversible encephalopathy syndrome (PRES) is a neurological condition characterized by specific clinical and radiological findings, often associated with severe systemic arterial hypertension.
- This case report focuses on the identification, diagnosis, and management of PRES within the pediatric population, highlighting its association with nephrotic syndrome.
Observation:
- A 10-year-old female presented with nephrotic syndrome, progressing to severe hypertension, visual loss, altered consciousness, and seizures.
- Initial CT scan revealed findings consistent with PRES, including hypodense areas in the occipital white matter.
Findings:
- PRES is caused by vasogenic cerebral edema and presents with symptoms such as headache, altered consciousness, seizures, and visual disturbances.
- Nephropathies, like nephrotic syndrome, are a primary cause of PRES in pediatric patients.
- MRI with diffusion-weighted imaging is the gold standard for diagnosing PRES.
Implications:
- Prompt diagnosis and management of PRES, including blood pressure reduction and supportive care, are essential for improving patient prognosis.
- Understanding the link between nephrotic syndrome and PRES in children is vital for timely intervention and minimizing neurological sequelae.
Introduction:
The posterior reversible encephalopathy (PRES) syndrome encompasses a set of clinical-radiological findings associated with severe systemic arterial hypertension. This case report proposes to discuss the identification, diagnosis, and management of PRES in the pediatric population.
Case Presentation:
Female patient, 10 years old, admitted to the emergency room with complaint of oliguria and generalized edema. At the initial physical exam, the only alteration present was anasarca. The diagnostic investigation revealed nephrotic syndrome, and clinical treatment was started. She evolved on the 8th day of hospitalization with peak hypertension, sudden visual loss, reduced level of consciousness, nystagmus, and focal seizures requiring intubation. She was transferred to the Intensive Care Unit, with neurological improvement, after the established therapy. CT scan revealed a discrete hypodense area in the white matter of the occipital lobe and anteroposterior groove asymmetry, compatible with PRES.
Discussion:
PRES is due to vasogenic cerebral edema of acute or subacute installation. Symptoms include headache and altered consciousness, stupor, coma, neurological deficits, seizures and cortical blindness. Nephropathies are the main cause of PRES in pediatrics. Magnetic resonance imaging with diffusion of molecules is the gold standard for diagnosis. The initial treatment objectives are the reduction of blood pressure, antiepileptic therapy, correction of hydroelectrolytic and acid-base disorders and management of intracranial hypertension.
Conclusion:
PRES is associated with acute hypertension. Early diagnosis and proper management may determine a better prognosis and minimize the severity of the clinical course.
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