Posterior reversible encephalopathy syndrome and the pediatric population

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Authors: Prasant Peter and Ann George
Date: May-August 2012
From: Journal of Pediatric Neurosciences(Vol. 7, Issue 2)
Publisher: Medknow Publications and Media Pvt. Ltd.
Document Type: Clinical report
Length: 1,360 words
Lexile Measure: 2130L

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Byline: Prasant. Peter, Ann. George

Posterior reversible encephalopathy syndrome presents with neurological and imaging features that are reversible, if prompt diagnosis and treatment is undertaken. However, the disease has been more commonly described in adult population, especially in eclampsia. In the background of predisposing factors like renal disease or chemotherapy, the pediatric population is also at equal risk for this condition, as we would like to present through this case and also demonstrate the potential for complete reversal of symptoms and imaging findings if diagnosed without delay.


Posterior reversible encephalopathy syndrome (PRES), first described by Hinchey et al . in 1996, [sup][1] is a clinical condition presenting with neurological symptoms including headache, seizures, altered sensorium, and loss of vision, and accompanied by characteristic magnetic resonance imaging (MRI) findings which are potentially reversible. Over the years, this condition has been described by various names including reversible posterior leukoencephalopathy, reversible posterior cerebral oedema, reversible occipitoparietal encephalopathy, and hypertensive encephalopathy. [sup][2] The disease has been more commonly described in adult population, [sup][3] especially in the setting of eclampsia and organ transplantation. [sup][4] Postulated underlying causes include sudden rise in blood pressure, immunosuppression, chemotherapeutic agents for lymphoma and leukemia, severe hypercalcemia, thrombocytopenic syndromes, Henoch-Schonlein purpura, vasculitis, and renal failure, [sup][1],[2],[5] of which sudden rise in blood pressure and renal failure appear to be the most common. [sup][2] At neuroimaging, vasogenic oedema is seen involving the white matter of bilateral cerebral hemispheres posteriorly, most commonly parietal and occipital lobes. [sup][1],[2]

The prevalence of PRES among children is not well established; however, there have been reports of PRES in children following chemotherapy and tumor lysis syndrome, as well as with hypertension. [sup][6]

Case Report

An 11-year-old boy, a known case of chronic kidney disease (stage V) on maintenance hemodialysis, presented with one episode of generalized tonic-clonic seizure approximately 30 minutes prior to presentation to the emergency center. He was in altered sensorium following the episode of seizure. There was history of high-grade fever (upto 103[degrees]F) for 3-4 days.

On examination, he was found to be...

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Gale Document Number: GALE|A309356027