RISK FACTORS, CLINICORADIOLOGICAL FINDINGS AND OUTCOME OF POSTERIOR REVERSIBLE ENCEPHALOPATHY SYNDROME IN CHILDREN

Objectives To study risk factors, clinicoradiological features and outcome of posterior reversible encephalopathy in children. Methods 30 patients of posterior reversible encephalopathy syndrome of either gender were enrolled from September 2019 to October 2021. Detailed history, physical examination and demographic data were recorded on proforma. All patients underwent routine blood chemistry, urine complete examination, complement level, inflammatory markers, ANA profile, anti d DNA, ultrasound abdomen, lipid profile, chest x ray, echocardiography and magnetic resonance. Data was analyzed in SPSS v22. Results Out of 30 patients, there was male predominance (53.3%) with male to female ratio of 1.14:1 and mean age of 10.86±2.22. Hypertension was present in (100%). Other features were seizures (93.3%), headache (83.3%), altered sensorium, speech loss (80%), visual impairment (70%), pyramidal tract signs (70%), peripheral edema (66.7%) and motor deficits (43.3%). Renal involvement was in 83.3% including post infectious glomerulonephritis 43.3%, systemic lupus erythromatosis 16.7%, chronic kidney disease 13.3% and atypical nephrotic syndrome 6.7%. Rare disorders included systemic vasculitis 10% and acute intermittent porphyria in 6.7% patients. T2W and FLAIR hyperintensities were present in bilateral occipital areas in (100%), bilateral parietal areas (90%), bilateral temporal areas (66.7%), frontal lobes 33.3% and cerebellum 50%. All recovered with only one patient having residual visual impairment. Follow up MRI scan showed disappearance of abnormal signals in 80% of cases. Conclusion Posterior reversible encephalopathy syndrome has variable clinicoradiological presentation with renal disorders being the commonest underlying etiology. High index of suspicion should be there for timely identification and management of these disorders.
Keywords: posterior reversible encephalopathy syndrome, hypertension, watershed areas