Ictal-interictal spectrum: an EEG warning sign of hypertensive encephalopathy
Pei-Hao Chen1, Hsin-Hui Wang1,2,3, Yi-Hsuan Tang1,3
1Department of Pediatrics, Taipei Veterans General Hospital, Taipei City, Taiwan.
Insights
Hypertensive encephalopathy in pediatric nephrotic syndrome can cause irreversible brain injury. Subclinical electroencephalographic activities, like lateralized periodic discharges, may worsen outcomes in posterior reversible encephalopathy syndrome (PRES).
Area of Science:
- Pediatric Nephrology
- Neurology
- Neurophysiology
Background:
- Hypertensive encephalopathy is a serious complication of pediatric nephrotic syndrome.
- Brain injury resulting from hypertensive encephalopathy may not always be reversible.
Purpose of the Study:
- To examine the neuroimaging and electroencephalographic findings in a case of IgA nephropathy with secondary hypertension leading to posterior reversible encephalopathy syndrome (PRES).
- To discuss the clinical implications of these findings, particularly the role of subclinical electroencephalographic activities.
Main Methods:
- Case report of a girl with IgA nephropathy and secondary hypertension.
- Correlation of neuroimaging and electroencephalographic findings.
- Discussion of clinical implications.
Main Results:
- Posterior reversible encephalopathy syndrome (PRES) was associated with lateralized periodic discharges on electroencephalogram (EEG).
- EEG findings were topographically concordant with neuroimaging.
- Clinically silent lateralized periodic discharges may increase cerebral metabolic demand and negatively impact neurological outcomes.
Conclusions:
- Electroencephalographic monitoring is recommended in PRES cases.
- EEG can detect subclinical brain electrical activities with potential therapeutic relevance.
Objective:
Hypertensive encephalopathy may complicate the course of pediatric nephrotic syndrome, and the resulting brain injury is not always reversible. Subclinical electroencephalographic activities may play a role in this context, as demonstrated by the case vignette.
Method:
We report on a girl with IgA nephropathy and secondary hypertension, leading to posterior reversible encephalopathy syndrome (PRES). The correlated neuroimaging and electroencephalographic findings are examined, and their clinical implications are discussed.
Results:
PRES could be associated with lateralized periodic discharges on electroencephalogram, which was topographically concordant with neuroimaging findings in this patient. Despite being clinically silent, the lateralized periodic discharges may potentially increase cerebral metabolic demand and adversely impact the neurological outcomes.
Conclusion:
Electroencephalographic monitoring should be considered in the context of PRES, as it may help detect subclinical electrical activities in the brain, which is of potential therapeutic relevance.
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