Last modified: 2014-04-03
Abstract
Introduction: Posterior reversible encephalopathy syndrome (PRES) is a specific clinic and radiologic entity first defined by Hinchey in 1996 and posteriorly refined by Casey in 2000, characterized by the presence of headache, consciousness impairment, seizures and visual abnormalities associated with an often symmetric transient vasogenic white matter edema which predominantly involves the posterior part of the brain. A variety of factors can precipitate PRES. However, studies in the pediatric group are restricted. Here we describe our experience in a pediatric intensive care unit along ten years. Methods: Retrospective survey of patients with diagnosis of PRES , focusing on etiology and MRI results, from May 2003 to August 2013 in Instituto da Criança do Hospital das Clínicas da Faculdade de Medicina da Univesidade de São Paulo. Results: We found fifteen confirmed cases in ten years. The median age was 10 years old (yo), range from 4 to 17 (yo). All subjects had acute elevation of blood pressure and focal seizures; 20% had visual symptoms and vomit and 33% had headache before presenting with seizure and conscious impairment. None of them went to status epilepticus and 80% had decreased level of consciousness. All underwent brain CT and MRI and 87% had involvement of the posterior part of the brain, 53% of the gray matter and 40% had ischemic complication. Two patients died in other hospitalizations and other two had neurological sequelae (epilepsy and behavior change). Conclusion: Even with ischemic events the rate of complications is low.
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References
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