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Ajmi H, Brahim J, Mabrouk S, Ben Abdallah A, Zouari N, Majdoub F, Nouir S, Hasni I, Ben Cheikh Y, Chemli J, Jemni H, Abroug S. Clinical and radiological findings of posterior reversible encephalopathy syndrome in children: About 16 children hospitalized in the pediatric department of a Tunisian tertiary care hospital. Eur J Paediatr Neurol 2023; 43:18-26. [PMID: 36871341 DOI: 10.1016/j.ejpn.2023.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 11/24/2022] [Accepted: 02/12/2023] [Indexed: 02/21/2023]
Abstract
BACKGROUND Posterior reversible encephalopathy syndrome (PRES) is a clinico-radiological entity most frequently described in young- or middle-aged adults with a rare occurrence among children. AIM To determine the clinical, radiological features and outcome of PRES in children admitted to a Tunisian tertiary care pediatric department. METHODS we retrospectively reviewed records of all children under 18 years old diagnosed with PRES and admitted to the PICU of the Pediatric department of Sahloul University Hospital from January 2000 to August 2021. RESULTS Sixteen patients were enrolled in this study. The mean age of the study population at PRES onset was 10 years (range: 4-14 years) and the male female ratio was 3. The most frequent neurological signs were seizures (n = 16 cases), headache (n = 8 cases), and impaired level of consciousness (7 cases). Visual disturbances were found in one patient. Arterial hypertension was the most underlying cause (16 cases). Brain MRI showed vasogenic edema, mostly localized in the parietal (13 cases) and occipital (11 cases) lobes. Moreover, cytotoxic edema (2 cases), pathologic contrast enhancement (1 case), and hemorrhage (3 cases) were isolated on MRI. The outcome after specific management was favorable after the first onset in 13 cases and death occurred in 3 patients. Relapses were observed in 4 patients. CONCLUSION Clinical features presented by children with PRES are variable and non-specific. MRI typically shows reversible posterior cerebral edema. However, in some cases, atypical neuro-imaging findings, such as cytotoxic edema infarction, hemorrhage and contrast enhancement can be observed.
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Affiliation(s)
- Houda Ajmi
- Department of Pediatrics, Sahloul Teaching Hospital, 4054, Sousse, Tunisia.
| | - Jawher Brahim
- Department of Pediatrics, Sahloul Teaching Hospital, 4054, Sousse, Tunisia
| | - Sameh Mabrouk
- Department of Pediatrics, Sahloul Teaching Hospital, 4054, Sousse, Tunisia
| | - Amel Ben Abdallah
- Department of Radiology, Sahloul Teaching Hospital, 4054, Sousse, Tunisia
| | - Noura Zouari
- Department of Pediatrics, Sahloul Teaching Hospital, 4054, Sousse, Tunisia
| | - Fadoua Majdoub
- Department of Pediatrics, Sahloul Teaching Hospital, 4054, Sousse, Tunisia
| | - Salsabil Nouir
- Department of Pediatrics, Sahloul Teaching Hospital, 4054, Sousse, Tunisia
| | - Ibtissem Hasni
- Department of Radiology, Sahloul Teaching Hospital, 4054, Sousse, Tunisia
| | - Yasser Ben Cheikh
- Department of Radiology, Sahloul Teaching Hospital, 4054, Sousse, Tunisia
| | - Jalel Chemli
- Department of Pediatrics, Sahloul Teaching Hospital, 4054, Sousse, Tunisia
| | - Hela Jemni
- Department of Radiology, Sahloul Teaching Hospital, 4054, Sousse, Tunisia
| | - Saoussan Abroug
- Department of Pediatrics, Sahloul Teaching Hospital, 4054, Sousse, Tunisia
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Li Y, Wang H, Han D, Wang Z, Zhang L, Yang S, Wang Q, Wen H, Fan H. Acute symptomatic seizure due to tacrolimus-related encephalopathy after liver transplantation: two case reports. J Int Med Res 2019; 47:6397-6403. [PMID: 31709865 PMCID: PMC7045690 DOI: 10.1177/0300060519883750] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Liver transplantation is suitable for acute and chronic liver diseases that cannot be cured by other methods. Immunosuppressants such as azathioprine, methylprednisolone, cyclophosphamide, cyclosporine A, and tacrolimus have been applied to prevent rejection after liver transplantation. Among them, tacrolimus is generally effective in resisting rejection, and its main adverse reaction is nephrotoxicity. Tacrolimus-induced seizures are rarely reported. The present report describes trismus, restlessness, and generalized muscle twitching in a 44-year-old man and a 59-year-old man who received tacrolimus after liver transplantation. Tacrolimus-induced epilepsy was diagnosed by clinical symptoms and video-electroencephalography. After the patients developed epileptic symptoms, they received intramuscular injections of diazepam and phenobarbital. When the symptoms were relieved, the patients were treated with oral levetiracetam tablets. The tacrolimus was immediately stopped, and the epilepsy symptoms gradually disappeared after treatment with sedatives and levetiracetam. The patients continued taking the levetiracetam for approximately 2 weeks. No evidence of seizures occurred during the next 8 months. Although tacrolimus is reportedly effective against rejection after liver transplantation, tacrolimus-induced epilepsy should be carefully managed to prevent death. Additionally, epilepsy may rarely occur in patients with a normal blood concentration of tacrolimus. Further study on the mechanism of such neurological complications is needed.
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Affiliation(s)
- Yao Li
- Medical College of Qinghai University, Xining, China.,Department of Hepatopancreatobiliary Surgery, The Affiliated Hospital of Qinghai University, Xining, China
| | - Haijiu Wang
- Department of Hepatopancreatobiliary Surgery, The Affiliated Hospital of Qinghai University, Xining, China
| | - Dongdong Han
- Department of Hepatopancreatobiliary Surgery, Beijing Tsinghua Changgung Hospital, Beijing, China
| | - Zhixin Wang
- Department of Hepatopancreatobiliary Surgery, The Affiliated Hospital of Qinghai University, Xining, China
| | - Li Zhang
- Medical College of Qinghai University, Xining, China.,Department of Hepatopancreatobiliary Surgery, The Affiliated Hospital of Qinghai University, Xining, China
| | - Shiwei Yang
- Department of Hepatopancreatobiliary Surgery, Beijing Tsinghua Changgung Hospital, Beijing, China
| | - Qiang Wang
- Department of Hepatopancreatobiliary Surgery, The Affiliated Hospital of Qinghai University, Xining, China
| | - Hao Wen
- Department of Hepatopancreatobiliary Surgery, First Affiliated Hospital of Xinjiang Medical University, Urmuqi, China
| | - Haining Fan
- Department of Hepatopancreatobiliary Surgery, The Affiliated Hospital of Qinghai University, Xining, China.,Qinghai Province Key Laboratory of Hydatid Disease Research, Xining, China
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Kamiya-Matsuoka C, Tummala S. Electrographic patterns in patients with posterior reversible encephalopathy syndrome and seizures. J Neurol Sci 2017; 375:294-298. [DOI: 10.1016/j.jns.2017.02.017] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2016] [Revised: 02/04/2017] [Accepted: 02/07/2017] [Indexed: 11/24/2022]
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Song T, Rao Z, Tan Q, Qiu Y, Liu J, Huang Z, Wang X, Lin T. Calcineurin Inhibitors Associated Posterior Reversible Encephalopathy Syndrome in Solid Organ Transplantation: Report of 2 Cases and Literature Review. Medicine (Baltimore) 2016; 95:e3173. [PMID: 27057842 PMCID: PMC4998758 DOI: 10.1097/md.0000000000003173] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Posterior reversible encephalopathy syndrome (PRES) is a rare neurologic side effect of calcineurin inhibitors (CNIs) with poorly understood clinical features.We report cases of 2 patients with PRES developing after kidney transplantation and summarize PRES clinical features through a literature review.The 1st case was a 28-year-old man who received a kidney transplant from a deceased donor. Initial immunosuppressive therapy consisted of tacrolimus/mycophenolate mofetil/prednisolone. He developed headache and blurred vision with visual field loss15 days after transplantation and generalized seizures 4 days later. The 2nd case was a 34-year-old man who received a living kidney transplant. His initial immunosuppressive therapy comprised tacrolimus/mycophenolate mofetil/prednisolone. Two months after transplantation, he developed seizures. Both patients were diagnosed with PRES based on neurological symptoms and magnetic resonance imaging (MRI) findings; they recovered after switching from tacrolimus to either a cyclosporine or a lower tacrolimus dose. CNI-associated PRES is an acute neurological syndrome with seizures, encephalopathy, visual abnormalities, headache, focal neurological deficits, and nausea/vomiting. It is always accompanied by hypertension. A fluid-attenuated inversion recovery signal MRI scan typically shows reversible subcortical white matter changes in the posterior cerebral hemisphere that usually occur within the 1st month after transplantation. CNI-associated PRES has a generally favorable prognosis with early diagnosis and prompt treatment including alternating or discontinuing CNIs and blood pressure control.CNI-associated PRES should be considered in patients exhibiting acute neurological symptoms after transplantation. Early diagnosis and immediate treatment are critical for a favorable prognosis.
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Affiliation(s)
- Turun Song
- From the Department of Urology, Institute of Urology, Organ Transplantation Center (TS, ZR, YQ, JL, ZH, XW, TL); and The Third Comprehensive Care Unit, West China Hospital, Sichuan University (QT), Chengdu, Sichuan, China
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Posterior Reversible Encephalopathy Syndrome After Transplantation: a Review. Mol Neurobiol 2015; 53:6897-6909. [PMID: 26666662 DOI: 10.1007/s12035-015-9560-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Accepted: 11/29/2015] [Indexed: 12/29/2022]
Abstract
Posterior reversible encephalopathy syndrome (PRES) is a rare neurological disease. Recently, an increase in the number of transplantations has led to more cases being associated with PRES than what was previously reported. Calcineurin inhibitors (CNIs) are major risk factors for PRES in posttransplantation patients. The mechanisms of the development of PRES remain to be unclear. The typical clinical symptoms of PRES include seizures, acute encephalopathy syndrome, and visual symptoms. The hyperintense signal on fluid-attenuated inversion recovery image is the characteristic of the imaging appearance in these patients. In addition, other abnormal signals distributed in multiple locations are also reported in some atypical cases. Unfortunately, PRES is often not recognized or diagnosed too late due to complicated differential diagnoses, such as ischemic stroke, progressive multifocal leukoencephalopathy, and neurodegenerative diseases. Thus, this review emphasizes the importance of considering the possibility of PRES when neurological disturbances appear after solid organ transplantation or hematopoietic cell transplantation. Moreover, this review demonstrates the molecular mechanisms of PRES associated with CNIs after transplantation, which aims to help clinicians further understand PRES in the transplantation era.
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PRES-ing for Answers About Long-Term Seizure Risk in Patients With Posterior Reversible Encephalopathy Syndrome. Epilepsy Curr 2015; 15:317-8. [PMID: 26633947 DOI: 10.5698/1535-7511-15.6.317] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Durán Paz S, Moreno Casanova I, Benatar-Haserfaty J. [Posterior reversible encephalopathy syndrome after neurosurgery: A literature review]. ACTA ACUST UNITED AC 2015; 62:585-9. [PMID: 25866131 DOI: 10.1016/j.redar.2015.03.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Revised: 01/23/2015] [Accepted: 03/03/2015] [Indexed: 11/17/2022]
Abstract
Posterior reversible encephalopathy syndrome is a clinical-radiological characterized by decreased level of consciousness, seizures, and visual disturbances, as well as radiologically ras brain edema, predominantly in parieto-occipital white matter regions. There are many situations that can trigger the disorder, including the administration of immunosuppressants, chemotherapy agents, hypertensive disorders, and sepsis. The case is described of a patient diagnosed with stage IV prostate adenocarcinoma, receiving chemotherapy, andundergoing a posterior reversible encephalopathy syndrome after surgery for resection of brain metastasis.
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Affiliation(s)
- S Durán Paz
- Servicio de Anestesiología, Hospital Universitario Ramón y Cajal, Madrid, España
| | - I Moreno Casanova
- Servicio de Anestesiología, Hospital Universitario Ramón y Cajal, Madrid, España
| | - J Benatar-Haserfaty
- Servicio de Anestesiología, Hospital Universitario Ramón y Cajal, Madrid, España.
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Datar S, Singh T, Rabinstein AA, Fugate JE, Hocker S. Long-term risk of seizures and epilepsy in patients with posterior reversible encephalopathy syndrome. Epilepsia 2015; 56:564-8. [DOI: 10.1111/epi.12933] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/05/2015] [Indexed: 11/27/2022]
Affiliation(s)
- Sudhir Datar
- Department of Neurology; Division of Critical Care Neurology; Wake Forest Baptist Health; Winston Salem North Carolina U.S.A
| | - Tarun Singh
- Department of Neurology; Division of Critical Care Neurology; Mayo Clinic; Rochester Minnesota U.S.A
| | - Alejandro A. Rabinstein
- Department of Neurology; Division of Critical Care Neurology; Mayo Clinic; Rochester Minnesota U.S.A
| | - Jennifer E. Fugate
- Department of Neurology; Division of Critical Care Neurology; Mayo Clinic; Rochester Minnesota U.S.A
| | - Sara Hocker
- Department of Neurology; Division of Critical Care Neurology; Mayo Clinic; Rochester Minnesota U.S.A
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Corsi E, Sathishkumar S, Shah RA, Kadry Z, McQuillan PM, Vaida SJ, Bezinover DS. Prolonged pentobarbital-induced coma for the treatment of severe seizures related to posterior reversible encephalopathy syndrome. ACTA ACUST UNITED AC 2014; 3:149-52. [PMID: 25612102 DOI: 10.1213/xaa.0000000000000093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
In this report, we describe a case of posterior reversible encephalopathy syndrome in a female patient after deceased donor liver transplantation. She developed posterior reversible encephalopathy syndrome on postoperative day 3 and did not improve despite adjustments in immunosuppressive therapy. The patient had symptoms of severe brain edema requiring maximal therapy, which included cooling, mannitol, 3% saline, and a pentobarbital infusion. Attempts to lighten the level of sedation failed because of recurring intractable seizure activity. Reductions in therapeutic support were ultimately successful after 62 days of continuous pentobarbital therapy. The patient awoke neurologically intact and was discharged to a rehabilitation center in good condition.
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Affiliation(s)
- Elviira Corsi
- From the *Department of Anesthesiology, †Department of Transplant Surgery, Penn State University, College of Medicine, Hershey Medical Center, Hershey, Pennsylvania; and ‡Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan
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Long-term Consequences of the Posterior Reversible Encephalopathy Syndrome in Eclampsia and Preeclampsia. Obstet Gynecol Surv 2014; 69:287-300. [DOI: 10.1097/ogx.0000000000000069] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Hayes D, Adler B, Turner TL, Mansour HM. Alternative tacrolimus and sirolimus regimen associated with rapid resolution of posterior reversible encephalopathy syndrome after lung transplantation. Pediatr Neurol 2014; 50:272-5. [PMID: 24405697 DOI: 10.1016/j.pediatrneurol.2013.11.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2013] [Revised: 10/31/2013] [Accepted: 11/12/2013] [Indexed: 11/17/2022]
Abstract
BACKGROUND Neurotoxicity is a significant complication of calcineurin inhibitor use, and posterior reversible encephalopathy syndrome has been reported. Limited data exist on the use of alternative immunosuppression regimens in the management of posterior reversible encephalopathy syndrome in transplant recipients. METHODS We present the immunosuppression management strategy of a girl who underwent bilateral lung transplantation for cystic fibrosis 6 months earlier, then suddenly developed a grand mal seizure due to posterior reversible encephalopathy syndrome diagnosed by magnetic resonance imaging of the brain. In an effort to reduce her tacrolimus dose, an alternative immunosuppressant regimen combining tacrolimus and sirolimus was used. RESULTS After the modification of her immunosuppressant regimen, there was rapid clinical improvement with no further seizures. Her brain findings had resolved on magnetic resonance imaging 2 months later. Over the next 6 months, allograft function remained stable and surveillance transbronchial biopsies found no allograft rejection on the combined sirolimus and tacrolimus therapy. CONCLUSIONS Tacrolimus-associated neurotoxicity resolved in a lung transplant recipient with a combined tacrolimus and sirolimus regimen. This combined therapy appears to be an effective alternative for lung transplant recipients that allow them to receive the benefits of both drugs but at lower doses, which reduces the risk for adverse effects.
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Affiliation(s)
- Don Hayes
- Department of Pediatrics, The Ohio State University College of Medicine, Nationwide Children's Hospital, Columbus, Ohio.
| | - Brent Adler
- Department of Radiology, The Ohio State University College of Medicine, Nationwide Children's Hospital, Columbus, Ohio
| | - Tiffany L Turner
- Department of Pediatrics, The Ohio State University College of Medicine, Nationwide Children's Hospital, Columbus, Ohio
| | - Heidi M Mansour
- Skaggs Center of Pharmaceutical Sciences, The University of Arizona-Tucson College of Pharmacy, Tucson, Arizona
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Maccora S, Ministeri CM, Fabbri R, Fabbri PG. The importance of neurophysiological assessment in posterior reversible encephalopathy syndrome: a case report of an eclamptic woman. Neurol Sci 2013; 34:2239-40. [DOI: 10.1007/s10072-013-1471-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2013] [Accepted: 05/30/2013] [Indexed: 11/25/2022]
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Ishikawa N, Kawaguchi H, Nakamura K, Kobayashi M. Central nervous system complications and neuroradiological findings in children with chronic active Epstein-Barr virus infection. Pediatr Int 2013; 55:72-8. [PMID: 23240920 DOI: 10.1111/ped.12024] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2012] [Revised: 08/15/2012] [Accepted: 09/19/2012] [Indexed: 01/11/2023]
Abstract
BACKGROUND Although many neurological complications have been described in acute Epstein-Barr virus infection, few reports have discussed the central nervous system complications in chronic active Epstein-Barr virus (CAEBV) infection. METHODS We retrospectively surveyed the medical records of 14 patients with CAEBV infection in our institute. Neuroradiological studies were performed in 10 of these patients. RESULTS Five had no neurological symptoms, whereas two presented with posterior reversible encephalopathy syndrome, one presented with basal ganglia calcification, and one presented with falx cerebri hemorrhage. Although both of the posterior reversible encephalopathy syndrome cases developed epilepsy several years after recovering from prolonged neurological deterioration, the others had no neurological sequelae. CONCLUSIONS This study revealed that various central nervous system complications may occur during the clinical course in pediatric CAEBV patients.
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Affiliation(s)
- Nobutsune Ishikawa
- Department of Pediatrics, Hiroshima University Graduate School of Biomedical Sciences, Hiroshima, Japan.
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Abstract
OPINION STATEMENT Solid organ transplantation is frequently complicated by a spectrum of seizure types, including single partial-onset or generalized tonic-clonic seizures, acute repetitive seizures or status epilepticus, and sometimes the evolution of symptomatic epilepsy. There is currently no specific evidence involving the transplant patient population to guide the selection, administration, or duration of antiepileptic drug (AED) therapy, so familiarity with clinical AED pharmacology and application of sound judgment are necessary for successful patient outcomes. An initial detailed search for symptomatic seizure etiologies, including metabolic, infectious, cerebrovascular, and calcineurin inhibitor treatment-related neurotoxic complications such as posterior reversible encephalopathy syndrome (PRES), is imperative, as underlying central nervous system disorders may impose additional serious risks to cerebral or general health if not promptly detected and appropriately treated. The mainstay for post-transplant seizure management is AED therapy directed toward the suspected seizure type. Unfavorable drug interactions could place the transplanted organ at risk, so choosing an AED with limited interaction potential is also crucial. When the transplanted organ is dysfunctional or vulnerable to rejection, AEDs without substantial hepatic metabolism are favored in post-liver transplant patients, whereas after renal transplantation, AEDs with predominantly renal elimination may require dosage adjustment to prevent adverse effects. Levetiracetam, gabapentin, pregabalin, and lacosamide are drugs of choice for treatment of partial-onset seizures in post-transplant patients given their efficacy spectrum, generally excellent tolerability, and lack of drug interaction potential. Levetiracetam is the drug of choice for primary generalized seizures in post-transplant patients. When intravenous drugs are necessary for acute seizure management, benzodiazepines and fosphenytoin are the traditional and best evidence-based options, although intravenous levetiracetam, valproate, and lacosamide are emerging options. Availability of several newer AEDs has greatly expanded the therapeutic armamentarium for safe and efficacious treatment of post-transplant seizures, but future prospective clinical trials and pharmacokinetic studies within this specific patient population are needed.
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Posterior reversible encephalopathy syndrome (PRES): electroencephalographic findings and seizure patterns. J Neurol 2011; 259:1383-9. [PMID: 22189837 DOI: 10.1007/s00415-011-6362-9] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2011] [Revised: 12/05/2011] [Accepted: 12/08/2011] [Indexed: 10/14/2022]
Abstract
To better describe seizure type, frequency, and electroencephalographic (EEG) findings in posterior reversible encephalopathy syndrome (PRES) and correlate these data with clinical and magnetic resonance imaging (MRI) data, we retrospectively assessed medical charts and EEG studies of patients with PRES treated between 2004 and 2011. Data collected included patients' underlying pathology, lesion distribution by MRI, seizure type and frequency, EEG pathologic background activity, focal pathology, and epileptogenic activity. Thirty-eight of 49 adults with PRES suffered from seizures; 17 underwent EEG and were included in the analysis. Perpetuating factors were similar to those reported in the literature. In 15 of 17 patients, MRI showed widespread involvement rather than purely occipital lesions. Nine patients had subcortical and cortical involvement. Seizures were single short grand mal (GM) in 11, serial GM in 2, recurrent GM in 2, and additional focal seizures in 2. No seizures were noted beyond the first day. After discontinuation of antiepileptic medication, no patients experienced seizure recurrence during 6-month follow-up. EEG showed diffuse theta/delta slowing in 13 patients and epileptogenic activity with focal sharp-wave and periodic lateralizing epileptiform discharges in 2 patients. Seizures in PRES are most commonly single GM and are usually of limited duration. EEG shows variable theta/delta slowing. Focal EEG pathology is seen in patients with focal seizures. Seizures occur early after disease onset and terminate spontaneously or under therapy during the first 24 h. Seizure recurrence beyond 24 h and chronic epilepsy were not seen. Seizures in PRES are frequent but appear to be uncomplicated and do not herald worse prognosis. EEG is helpful in evaluating the degree of encephalopathy and monitoring epileptic activity. Long-term antiepileptic medication does not appear to be warranted.
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McCoy B, King M, Gill D, Twomey E. Childhood posterior reversible encephalopathy syndrome. Eur J Paediatr Neurol 2011; 15:91-4. [PMID: 21074464 DOI: 10.1016/j.ejpn.2010.10.002] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2008] [Revised: 10/15/2010] [Accepted: 10/21/2010] [Indexed: 12/21/2022]
Abstract
Posterior Reversible Encephalopathy Syndrome (PRES) is a clinicoradiologic syndrome characterised clinically by headaches, altered consciousness, visual disturbances and seizures and radiological changes which can resolve. However left untreated it can be fatal and not all cases are reversible. It can occur in many settings, the most common being hypertensive crisis. We discuss the clinical and radiological features of this increasingly diagnosed condition among children and current thinking on its pathogenesis. A brief case is used to highlight the variable presentation of PRES. PRES is often unsuspected by the clinician and radiologists may be first to suggest the diagnosis. Accurate assessment including blood pressure measurement, appropriate imaging and rapid treatment is required to avoid a devastating outcome.
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Affiliation(s)
- Bláthnaid McCoy
- Department of Neurology, Children's University Hospital, Temple Street, Dublin 7, Ireland.
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