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Posterior reversible encephalopathy syndrome in children with malignancies - a single-center retrospective study
Aleksandra Kiermasz1, Magdalena Zapała2, Bartosz Zwiernik2
1Department of Oncology, Hematology, and Chemotherapy, Upper Silesia Children's Care Health Centre, Katowice, Poland.
Insights
Posterior reversible encephalopathy syndrome (PRES) affects 1.8% of pediatric cancer patients, presenting with diverse symptoms and typical MRI findings. Early diagnosis and treatment are crucial for managing this rare complication.
Area of Science:
- Neurology
- Pediatric Oncology
- Radiology
Background:
- Posterior reversible encephalopathy syndrome (PRES) is diagnosed using clinical and radiological features.
- PRES symptoms include neurological deficits, seizures, and intracranial hypertension.
- Epidemiology and outcomes of PRES in pediatric cancer patients are not well-documented.
Purpose of the Study:
- To evaluate the clinical and radiological presentation of PRES in pediatric cancer patients.
- To determine the outcome of PRES in this specific population.
- To assess the incidence of PRES in children with cancer at a single center.
Main Methods:
- Retrospective analysis of 1,053 pediatric cancer patients over 15 years.
- Determined the incidence of PRES.
- Reviewed clinical symptoms, radiological findings (MRI), and treatment requirements.
Main Results:
- 1.8% (19/1053) of patients developed PRES.
- Common symptoms included hypertension, seizures, altered mental status, and headaches.
- 73.7% (14/19) had typical PRES MRI findings; 21% required ICU care.
Conclusions:
- PRES is a rare but significant complication in pediatric cancer patients.
- Clinical criteria for PRES diagnosis in pediatric oncology need further refinement.
- Research into risk factors for recurrent PRES, especially with chemotherapy, is warranted.
Background:
Posterior reversible encephalopathy syndrome (PRES) diagnosis relies on clinical and radiological characteristics. Clinical manifestations include focal neurologic deficits, hemiparesis, seizures with symptoms of intracranial hypertension, headache, nausea, vomiting, and visual field disturbances. The majority of patients have typical changes in magnetic resonance imaging. The epidemiology and outcomes of PRES in the pediatric cancer population have not been well described. Most of the available data are from retrospective analyses.
Objective:
The aim of our study was to evaluate the clinical and radiological presentation as well as the outcome of PRES in children treated for cancers in a single center.
Methods:
We analyzed data from 1,053 patients diagnosed with malignancies in a single center over 15 years to determine the incidence of PRES.
Results:
19/1053 (1.8%) patients developed PRES. The diagnosis was accompanied by a range of clinical symptoms including hypertension, seizures, altered mental status, and headaches. Magnetic resonance imaging was performed in all patients, and 14/19 (73.7%) exhibited typical findings consistent with PRES. Four patients (21.0%) required treatment in the Intensive Care Unit.
Conclusion:
Posterior reversible encephalopathy syndrome (PRES) is a rare but significant complication in children with cancer.There is a clear need to establish clinical criteria for PRES to improve the diagnosis and treatment of patients with PRES, particularly in the pediatric oncological population.Further studies are needed to identify the risk factors for recurrent PRES, particularly in pediatric cancer patients undergoing chemotherapy or immunosuppressive treatment.
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