Supporting Data doc 4.4MB

POSTERIOR REVERSIBLE ENCEPHALOPATHY SYNDROME IN PEDIATRICS

OBJECTIVE: To report three pediatric cases of posterior reversible encephalopathy (PRES). MATERIALS AND METHODS: Retrospective and descriptive review, based on digital patient medical records. #1: 8-year-old girl with diffuse pontine glioma. After a biopsy, patient presented acute deterioration of consciousness, in the context of HTN. MRI showed vascular congestion and leptomeningeal enhancement. (Figure 1) With a diagnosis of PRES, anti-HTN treatment was implemented, reversing the acute symptoms. (Figure 2). #2: 15-year-old girl with hemorrhagic stroke secondary to left cerebellar arteriovenous malformation (AVM) which was partially embolized and resected with evacuation of the cerebellar hematoma. Twenty-five days later, patient presented a seizure and HTN was recorded. On MRI, areas of bilateral upper parietal cortico-subcortical edema were observed. Four antihypertensive drugs were required for pressure control. (Figure 3). #3: 12-year-old boy presenting debut diabetic ketoacidosis during intercurrent infection. Sustained hypertension and later GCT seizure were recorded. MRI showed predominantly posterior hyperintense cortico-subcortical lesions, compatible with PRES. Antihypertensive treatment resolved neurological symptoms. (Figure 4) CONCLUSION: PRES is of low prevalence in the pediatric population which can delay diagnosis. Although no specific diagnostic criteria have been established, both acute and subacute clinical characteristics have been described which, associated with neuroimaging findings in the context of HTN, suggest vasogenic edema. Proper management of hypertension favors symptom reversal, as observed in all 3 patients described. No reported cases of PRES associated with AVM were found in the literature.
Keywords: Posterior reversible encephalopathy syndrome, hypertension.