Posterior reversible encephalopathy syndrome in a child following hypovolemic shock: a case report

Posterior reversible encephalopathy syndrome (PRES) is a condition that causes a wide range of clinical neurological manifestations like headache, seizures, visual changes, and altered mental sensations. It is diagnosed with the help of sequential neuroimaging findings. Manifestations may occur a few hours to months after the initial precipitating cause. In the pediatric population, the most common cause is hypertension caused by renal disease or different drugs.

Here, the authors present the case of a 4-year-old boy with a significant medical history of acute gastroenteritis following hypovolemic shock that later developed white matter edema of the brain on T2-weighted MRI scans along with symptoms such as headache and vomiting. Here, the patient was managed symptomatically with antiepileptic medication as prophylaxis.

PRES is a rare neurological diagnosis made in the child that presents with headache, vomiting, blurring of vision, and abnormal body movements, which have several etiology like hypertension, glomerulonephritis, organ transplant, drugs, and very rarely with hypovolemic shock. It is an acute reversible condition in which a person presents with visual disturbances, headaches, and seizures. Seizures present as a life-threatening situation, so antiepileptic drugs are used as early prophylaxis.

PRES is a reversible neurological condition, and prognosis is typically favorable if recognized and treated early, with symptom improvement or resolution in a few days to several weeks. Complications of PRES develop if the disease is not treated promptly. Complications include focal neurologic deficits from ischemic injury and epilepsy.