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Posterior Reversible Encephalopathy Syndrome Complicating the Postoperative Clinical Course in a Child with a
Akhil Sunil1, Saritha Aryan1, Sumit Thakar1
1Department of Neurosurgery, Sri Sathya Sai Institute of Higher Medical Sciences, Bangalore, Karnataka State, India.
Insights
Posterior reversible encephalopathy syndrome (PRES) can occur without typical risk factors. This case highlights PRES development in a pediatric neurosurgical patient with hepatic and hypothalamic dysfunction, emphasizing the need for broader differential diagnoses.
Area of Science:
- Neurology
- Neurosurgery
- Pediatrics
Background:
- Posterior reversible encephalopathy syndrome (PRES) is a rare neurological condition typically associated with hypertension, renal failure, sepsis, autoimmune diseases, and immunosuppression.
- Previous neurosurgical literature has documented PRES in 20 cases, predominantly linked to hypertension or chemotherapy.
- This report focuses on an atypical presentation of PRES in a pediatric neurosurgical patient.
Approach:
- A 9-year-old boy underwent surgical resection of a suprasellar craniopharyngioma.
- Postoperatively, the patient developed hepatic failure and hypothalamic dysfunction, managed conservatively.
- Clinical and radiological findings indicative of PRES emerged 10 days post-complication onset.
Key Points:
- The patient presented with PRES in the absence of common risk factors like hypertension or immunosuppression.
- Hepatic failure and hypothalamic dysfunction were identified as potential contributing factors in this unique case.
- The PRES symptoms demonstrated resolution upon follow-up.
Conclusions:
- This case expands the understanding of PRES etiology, particularly in the neurosurgical context.
- It underscores the importance of considering PRES in pediatric patients with unexplained neurological deficits, even without typical risk factors.
- Further research into the pathogenesis of PRES in non-traditional settings is warranted.
Abstract:
Posterior reversible encephalopathy syndrome (PRES) is an unusual neurological condition known to occur in the setting of various risk factors such as acute hypertension, renal failure, sepsis, multiorgan failure, autoimmune disease, and immunosuppression. Twenty cases of PRES have been previously reported in neurosurgical literature, almost all of which were attributed to either hypertension or chemotherapeutic drugs. Herein, we report a case of PRES in a neurosurgical patient in the absence of the commonly described risk factors for the syndrome. The patient was a 9-year-old boy who underwent uneventful transcranial resection of a suprasellar craniopharyngioma. His postoperative clinical course was complicated by hepatic failure and hypothalamic dysfunction, both of which were managed conservatively. Ten days after the onset of these complications, he developed clinical and radiological features suggestive of PRES which eventually resolved at follow-up. We discuss the pathogenesis of this unusual neurological syndrome in our patient in the light of a literature review.
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