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Ghali MGZ, Styler MJ. Etiologies, Cerebral Vasomotion, and Endothelial Dysfunction in the Pathophysiology of Posterior Reversible Encephalopathy Syndrome in Pediatric Patients. JOURNAL OF PEDIATRIC NEUROLOGY 2020. [DOI: 10.1055/s-0040-1702934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
AbstractThe posterior reversible encephalopathy syndrome was characterized by Hinchey and colleagues in the 1990s. The condition frequently afflicts patients suffering from hematologic and solid organ malignancy and individuals undergoing transplantation. Cases are more frequently described in the adult population compared with children. In the pediatric population, malignancy, transplantation, renal disease, and hypertension represent the most common etiologies. Theories on pathogenesis have centered upon cerebrovascular dysautoregulation with increases in blood–brain barrier permeability. This generates vasogenic edema of the cerebral parenchyma and consequent neurologic deficits. The parietal and occipital lobes are affected with greatest prevalence, though frontal and temporal lobe involvement is frequent, and that of the contents of the infratentorial posterior cranial fossa are occasionally described. The clinical presentation involves a characteristic constellation of neurologic signs and symptoms, most typically inclusive of headache, visual-field disturbances, abnormalities of visual acuity, and seizures. Supportive care, withdrawal of the offending agent, antihypertensive therapy, and prophylactic anticonvulsants affect convalescence in majority of cases. The principal challenge lies in identifying the responsible agent precipitating the condition in patients with malignancy and those having undergone transplantation and thus deciding which medication among a multidrug treatment regimen to withhold, the duration of drug cessation required to effect clinical resolution, and the safety of resuming treatment with the compound. We accordingly reviewed and evaluated the literature discussing the posterior reversible encephalopathy syndrome in children.
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Affiliation(s)
- Michael G. Z. Ghali
- Department of Neurological Surgery, Houston Methodist Hospital, Houston, Texas, United States
| | - Michael J. Styler
- Department of Hematology and Oncology, Hahnemann University Hospital, Philadelphia, Pennsylvania, United States
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Pirola JP, Baenas DF, Haye Salinas MJ, Benzaquén NR, Colazo M, Borghi MV, Lucero C, Álvarez AC, Retamozo S, Alvarellos A, Saurit V, Caeiro F. Posterior reversible leukoencephalopathy syndrome: Case series and review of the literature. REUMATOLOGIA CLINICA 2020; 16:169-173. [PMID: 29859809 DOI: 10.1016/j.reuma.2018.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 04/19/2018] [Accepted: 04/19/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To describe clinical manifestations, antecedents, comorbidities and associated treatments, imaging findings, and follow-up in patients with posterior reversible encephalopathy syndrome. METHODS A retrospective, descriptive analysis of admitted patients was performed between June 2009 and May 2014 in a third-level care hospital. We evaluated age, sex, comorbidities, symptoms, values of blood pressure at admission, renal function, medication and time elapsed until the disappearance of symptoms. RESULTS Thirteen patients were included. In all, 77% of them had a history of hypertension at baseline and 85% had impaired renal function. The most prevalent comorbidity was renal transplantation, and 85% had deterioration of renal function. Five of the patients had undergone renal transplantation. The most common clinical manifestation was seizures. All had subcortical lesions and bilateral parietooccipital involvement was the finding most frequently observed. CONCLUSION This syndrome should be taken into account in the differential diagnoses of patients presenting with acute neurological syndromes and the abovementioned risk factors.
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Affiliation(s)
- Juan Pablo Pirola
- Servicio de Reumatología, Hospital Privado Universitario de Córdoba, Córdoba, Argentina
| | - Diego Federico Baenas
- Servicio de Reumatología, Hospital Privado Universitario de Córdoba, Córdoba, Argentina.
| | | | | | - Marcela Colazo
- Servicio de Reumatología, Hospital Privado Universitario de Córdoba, Córdoba, Argentina
| | - María Victoria Borghi
- Servicio de Neurología, Hospital Privado Universitario de Córdoba, Córdoba, Argentina
| | - Cecilia Lucero
- Servicio de Neurología, Hospital Privado Universitario de Córdoba, Córdoba, Argentina
| | - Ana Cecilia Álvarez
- Servicio de Reumatología, Hospital Privado Universitario de Córdoba, Córdoba, Argentina
| | - Soledad Retamozo
- Servicio de Reumatología, Hospital Privado Universitario de Córdoba, Córdoba, Argentina
| | - Alejandro Alvarellos
- Servicio de Reumatología, Hospital Privado Universitario de Córdoba, Córdoba, Argentina
| | - Verónica Saurit
- Servicio de Reumatología, Hospital Privado Universitario de Córdoba, Córdoba, Argentina
| | - Francisco Caeiro
- Servicio de Reumatología, Hospital Privado Universitario de Córdoba, Córdoba, Argentina
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Seizures in patients with a phaeochromocytoma/paraganglioma (PPGL): A review of clinical cases and postulated pathological mechanisms. Rev Neurol (Paris) 2019; 175:495-505. [PMID: 31133278 DOI: 10.1016/j.neurol.2018.11.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Revised: 06/30/2018] [Accepted: 11/05/2018] [Indexed: 11/24/2022]
Abstract
The purpose of this work was to expound on the postulated pathological mechanisms through which pheochromocytoma/paraganglioma (PPGL) can cause seizures by conducting a comprehensive review of ten cases and several pathogenic mechanisms. The goal was to enhance awareness amongst doctors and researchers about patients with PPGL presenting with seizures. This would help decrease the risk of misdiagnosis and mismanagement in future clinics. Additionally, this review was written with the purpose to attract more attention to etiological explorations, particularly concerning rare causes of seizures, which is consistent with the idea that League Against Epilepsy (ILAE) has emphasized in the new version of the ILAE position paper published in 2017. It is of great importance to keep in mind the fact that seizures can constitute an atypical presentation of PPGL and to establish early diagnosis and accurate cure for these patients, especially in the presence of paroxysmal hypertension or other suggestive symptoms of PPGL.
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Ahn CH, Han SA, Kong YH, Kim SJ. Clinical characteristics of hypertensive encephalopathy in pediatric patients. KOREAN JOURNAL OF PEDIATRICS 2017; 60:266-271. [PMID: 29042869 PMCID: PMC5638725 DOI: 10.3345/kjp.2017.60.8.266] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Revised: 05/21/2017] [Accepted: 06/12/2017] [Indexed: 12/25/2022]
Abstract
Purpose The aim of this study was to assess the clinical characteristics of hypertensive encephalopathy according to the underlying etiologies in children. Methods We retrospectively evaluated 33 pediatric patients who were diagnosed as having hypertensive encephalopathy in Chonbuk National University Children's Hospital. Among the patients, 18 were excluded because of incomplete data or because brain magnetic resonance imaging (MRI) was not performed. Finally, 17 patients were enrolled and divided into a renal-origin hypertension group and a non-renal-origin hypertension group according to the underlying cause. We compared the clinical features and brain MRI findings between the 2 groups. Results The renal group included renal artery stenosis (4), acute poststreptococcal glomerulonephritis (2), lupus nephritis (2), and acute renal failure (1); the nonrenal group included essential hypertension (4), pheochromocytoma (2), thyrotoxicosis (1), and acute promyelocytic leukemia (1). The mean systolic blood pressure of the renal group (172.5±36.9 mmHg) was higher than that of the nonrenal group (137.1±11.1 mmHg, P<0.05). Seizure was the most common neurologic symptom, especially in the renal group (P<0.05). Posterior reversible encephalopathy syndrome (PRES), which is the most typical finding of hypertensive encephalopathy, was found predominantly in the renal group as compared with the nonrenal group (66.6% vs. 12.5%, P<0.05). Conclusion We conclude that the patients with renal-origin hypertension had a more severe clinical course than those with non-renal-origin hypertension. Furthermore, the renal-origin group was highly associated with PRES on brain MRI.
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Affiliation(s)
- Chang Hoon Ahn
- Department of Pediatrics, Chonbuk National University Medical School, Jeonju, Korea
| | - Seung-A Han
- Department of Pediatrics, Chonbuk National University Medical School, Jeonju, Korea
| | - Young Hwa Kong
- Department of Pediatrics, Chonbuk National University Medical School, Jeonju, Korea
| | - Sun Jun Kim
- Department of Pediatrics, Chonbuk National University Medical School, Jeonju, Korea.,Research Institute of Clinical Medicine, Chonbuk National University Medical School, Jeonju, Korea
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Posteriyor Reversibl Ensefalopati Sendromu (PRES) ve Hayat Kurtarıcı Yoğun Bakım Ünitesi. ANADOLU KLINIĞI TIP BILIMLERI DERGISI 2017. [DOI: 10.21673/anadoluklin.252168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Zhang L, Wang Y, Shi L, Cao J, Li Z, Wáng YXJ. Late postpartum eclampsia complicated with posterior reversible encephalopathy syndrome: a case report and a literature review. Quant Imaging Med Surg 2016; 5:909-16. [PMID: 26807372 DOI: 10.3978/j.issn.2223-4292.2015.12.04] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Posterior reversible encephalopathy syndrome (PRES) is a rare but serious clinical-neuroradiological entity characterized by headache, vomiting, visual disturbances, altered mental status, seizures, and unconsciousness associated with the characteristic imaging findings including sub-cortical vasogenic edema at the bilateral parietal and occipital lobes. We describe a case of 28-year-old PRES patient secondary to delayed maternal postpartum eclampsia. This patient was not initially diagnosed with pre-eclampsia and PRES. The diagnosis was established after magnetic resonance imaging. After treatment this patient's PRES resolved. Early diagnosis and treatment are the keys to reverse PRES. A literature review for PRES is provided in this report.
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Affiliation(s)
- Lihong Zhang
- 1 Department of Neurology, the Second Hospital of Hebei Medical University, Shijiazhuang 050000, China ; 2 Department of Ophthalmology, the Fourth Hospital of Shijiazhuang, Shijiazhuang 050011, China ; 3 Department of Radiology, 4 Department of Orthopedics, the First Hospital of Shijiazhuang, Shijiazhuang 050011, China ; 5 Department of Imaging and Interventional Radiology, the Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China
| | - Yacong Wang
- 1 Department of Neurology, the Second Hospital of Hebei Medical University, Shijiazhuang 050000, China ; 2 Department of Ophthalmology, the Fourth Hospital of Shijiazhuang, Shijiazhuang 050011, China ; 3 Department of Radiology, 4 Department of Orthopedics, the First Hospital of Shijiazhuang, Shijiazhuang 050011, China ; 5 Department of Imaging and Interventional Radiology, the Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China
| | - Liang Shi
- 1 Department of Neurology, the Second Hospital of Hebei Medical University, Shijiazhuang 050000, China ; 2 Department of Ophthalmology, the Fourth Hospital of Shijiazhuang, Shijiazhuang 050011, China ; 3 Department of Radiology, 4 Department of Orthopedics, the First Hospital of Shijiazhuang, Shijiazhuang 050011, China ; 5 Department of Imaging and Interventional Radiology, the Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China
| | - Jianhui Cao
- 1 Department of Neurology, the Second Hospital of Hebei Medical University, Shijiazhuang 050000, China ; 2 Department of Ophthalmology, the Fourth Hospital of Shijiazhuang, Shijiazhuang 050011, China ; 3 Department of Radiology, 4 Department of Orthopedics, the First Hospital of Shijiazhuang, Shijiazhuang 050011, China ; 5 Department of Imaging and Interventional Radiology, the Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China
| | - Zhenzhong Li
- 1 Department of Neurology, the Second Hospital of Hebei Medical University, Shijiazhuang 050000, China ; 2 Department of Ophthalmology, the Fourth Hospital of Shijiazhuang, Shijiazhuang 050011, China ; 3 Department of Radiology, 4 Department of Orthopedics, the First Hospital of Shijiazhuang, Shijiazhuang 050011, China ; 5 Department of Imaging and Interventional Radiology, the Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China
| | - Yì-Xiáng J Wáng
- 1 Department of Neurology, the Second Hospital of Hebei Medical University, Shijiazhuang 050000, China ; 2 Department of Ophthalmology, the Fourth Hospital of Shijiazhuang, Shijiazhuang 050011, China ; 3 Department of Radiology, 4 Department of Orthopedics, the First Hospital of Shijiazhuang, Shijiazhuang 050011, China ; 5 Department of Imaging and Interventional Radiology, the Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China
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Furtado A, Hsu A, La Colla L, Zuccoli G. Arterial blood pressure but not serum albumin concentration correlates with ADC ratio values in pediatric posterior reversible encephalopathy syndrome. Neuroradiology 2015; 57:721-8. [DOI: 10.1007/s00234-015-1511-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Accepted: 03/11/2015] [Indexed: 11/28/2022]
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Araz C, Camkiran A, Zeyneloglu P, Sezgin A, Moray G, Pirat A, Arslan G. Early-Onset Posterior Reversible Encephalopathy Syndrome After Solid Organ Transplantation in Pediatric Patients: A Report of 2 Cases. Transplant Proc 2013; 45:3555-7. [DOI: 10.1016/j.transproceed.2013.08.101] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Ermeidi E, Balafa O, Spanos G, Zikou A, Argyropoulou M, Siamopoulos KC. Posterior reversible encephalopathy syndrome: a noteworthy syndrome in end-stage renal disease patients. Nephron Clin Pract 2013; 123:180-4. [PMID: 23921191 DOI: 10.1159/000353731] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2012] [Accepted: 06/10/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Posterior reversible encephalopathy syndrome (PRES) is a clinico-radiologic entity characterized by headache, visual disturbances, seizures, and the presence of edema on MRI scan, predominantly in the posterior white matter. Regarding end-stage renal disease (ESRD) and PRES, only a few cases of children on peritoneal dialysis (PD) and adults on hemodialysis have been described in the literature. CASES We report 4 cases of adult patients on PD who presented with PRES, all of which were due to hypertension and inadequate management of fluid balance. The patients expressed typical PRES symptoms such as headache, visual disorders, and tonic/clonic seizures. The patients recovered completely and the MRI lesions disappeared after strict control of volume status. CONCLUSION Nephrologists should be aware of the syndrome, especially when they manage hypertensive ESRD patients not compliant with the fluid and diet restrictions. MRI scan is the only diagnostic tool for defining the syndrome. Early diagnosis is important, since complete remission is achieved after appropriate treatment.
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Affiliation(s)
- Eleni Ermeidi
- Department of Nephrology, University Hospital of Ioannina, Ioannina, Greece
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Schusse CM, Peterson AL, Caplan JP. Posterior Reversible Encephalopathy Syndrome. PSYCHOSOMATICS 2013; 54:205-11. [PMID: 23473451 DOI: 10.1016/j.psym.2013.01.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2012] [Revised: 01/23/2013] [Accepted: 01/24/2013] [Indexed: 10/27/2022]
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Gómez-González C, Rubio-Murillo P, González-Maestre J, Martín de Pablos J. [Reversible posterior encephalopathy during pregnancy and/or puerperium in the intensive care unit]. Med Intensiva 2011; 36:236-7. [PMID: 21733596 DOI: 10.1016/j.medin.2011.05.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2011] [Revised: 05/12/2011] [Accepted: 05/14/2011] [Indexed: 11/25/2022]
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Petrovic BD, Nemeth AJ, McComb EN, Walker MT. Posterior reversible encephalopathy syndrome and venous thrombosis. Radiol Clin North Am 2011; 49:63-80. [PMID: 21111130 DOI: 10.1016/j.rcl.2010.07.016] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Posterior reversible encephalopathy syndrome (PRES) and venous thrombosis are frequently encountered first in the emergency setting and share some common characteristics. The clinical presentation in both entities is vague, and the brain parenchymal findings of PRES syndrome may resemble those of venous thrombosis in some ways. Both entities often occur in a bilateral posterior distribution and may be associated with reversible parenchymal findings if the inciting factor is treated. These diagnoses should be at the forefront of the differential diagnosis when confronted with otherwise unexplained brain edema, among other findings described in this article.
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Affiliation(s)
- Bojan D Petrovic
- Neuroradiology Section, Department of Radiology, NorthShore University HealthSystem, 2650 Ridge Avenue, Evanston, IL 60201, USA.
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Panis B, Vlaar AMM, van Well GTJ, Granzen B, Weber JW, Postma AA, Klinkenberg S. Posterior reversible encephalopathy syndrome in paediatric leukaemia. Eur J Paediatr Neurol 2010; 14:539-45. [PMID: 20171912 DOI: 10.1016/j.ejpn.2010.01.003] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2009] [Revised: 12/25/2009] [Accepted: 01/25/2010] [Indexed: 11/17/2022]
Abstract
This report describes four patients with acute lymphoblastic leukaemia, suffering from posterior reversible encephalopathy syndrome during the induction period of treatment. A review of the literature on posterior reversible encephalopathy syndrome in paediatric leukaemia is given. The exact mechanism of posterior reversible encephalopathy syndrome is not clear and seems to be multifactorial. Hypertension is likely to play a major role in the development but could be also secondary. All patients in this case series presented after introduction of the new induction protocol for acute lymphoblastic leukaemia. Treatment of hypertension is likely to have a favourable role and posterior reversible encephalopathy syndrome is most often reversible. It is important to consider this diagnosis during the induction phase of leukaemia treatment in the presence of neurological symptoms. The incidence of PRES in the induction scheme should be investigated, in order to optimize the ALL treatment.
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Affiliation(s)
- Bianca Panis
- Department of Paediatrics, Maastricht University Medical Center, Maastricht, The Netherlands.
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Muscal E, Traipe E, de Guzman MM, Myones BL, Brey RL, Hunter JV. MR imaging findings suggestive of posterior reversible encephalopathy syndrome in adolescents with systemic lupus erythematosus. Pediatr Radiol 2010; 40:1241-5. [PMID: 20119723 DOI: 10.1007/s00247-009-1540-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2009] [Revised: 12/04/2009] [Accepted: 12/24/2009] [Indexed: 11/26/2022]
Abstract
BACKGROUND Endothelial damage, hypertension and cytotoxic medications may serve as risk factors for the posterior reversible encephalopathy syndrome (PRES) in systemic lupus erythematosus. There have been few case reports of these findings in pediatric lupus patients. OBJECTIVE We describe clinical and neuroimaging findings in children and adolescents with lupus and a PRES diagnosis. MATERIALS AND METHODS We identified all clinically acquired brain MRIs of lupus patients at a tertiary care pediatric hospital (2002-2008). We reviewed clinical features, conventional MRI and diffusion-weighted imaging (DWI) findings of patients with gray- and white-matter changes suggestive of vasogenic edema and PRES. RESULTS Six pediatric lupus patients presenting with seizures and altered mental status had MRI findings suggestive of PRES. In five children clinical and imaging changes were seen in conjunction with hypertension and active renal disease. MRI abnormalities were diffuse and involved frontal regions in five children. DWI changes reflected increased apparent diffusivity coefficient (unrestricted diffusion in all patients). Clinical and imaging changes significantly improved with antihypertensive and fluid management. CONCLUSION MRI changes suggestive of vasogenic edema and PRES may be seen in children with active lupus and hypertension. The differential diagnosis of seizures and altered mental status should include PRES in children, as it does in adults.
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Affiliation(s)
- Eyal Muscal
- Baylor College of Medicine and Pediatric Rheumatology Center, Texas Children's Hospital, 6621 Fannin St., MC 3-2290, Houston, TX 77030, USA.
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Vijayalakshmi B, Sethna F, Manford M, Lees CC. Posterior reversible encephalopathy syndrome in a patient with HELLP syndrome complicating a triploid pregnancy. J Matern Fetal Neonatal Med 2009; 23:938-43. [DOI: 10.3109/14767050903317690] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Finsterer J, Stöllberger C, Ostermann E, Zuntner G, Huber J, Tscherney R. Recurrent posterior reversible encephalopathy syndrome in mitochondrial disorder. Blood Press 2009; 18:126-9. [DOI: 10.1080/08037050902975106] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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