Diagnosis and treatment of posterior reversible encephalopathy syndrome in children

Objective Three patients with posterior reversible encephalopathy syndrome (PRES) in childhood were reviewed retrospectively in this study.There were 1 case(case 1) with hypertension due to hyperreninism, and 2 patients (case 2 and case 3)with induction chemotherapy for childhood acute lymphoblastic leukemia (ALL). Clinical radiological features, electroencephalogram (EEG) data and neurological outcomes of the cases were analyzed with related literature reviews to highlight the clinical features of PRES in childhood. Methods Retrospective analysis was made in terms of etiology, clinical manifestations, magnetic resonance imaging (MRI) scanning of the brain, EEG and neurological outcomes of 3 cases of PRES. Results Present symptoms included seizures, altered mental function, hea-dache and visual disturbance, with hypertension or the blood pressure 25% higher than the baseline.Typical PRES findings were seen in 2 patients, consisting of bilateral symmetrical in parietal and occipital lobes, and 1 case with extensive involvement in bilateral frontotemporal lobe in adition.Case 2 and case 3 had epileptiform discharges on their EEG, while continuous EEG monitoring found non-convulsive status epilepticus(NCSE) in case 3 who had experienced status epilepticus(SE). Case 1 showed complete recovery after antihypertensive treatment during the acute stage; Associated offending chemotherapeutic agents were withdrawn in both case 2 and case 3, while dexamethasone plus variety of anti-epileptic agents were provided in case 3, and case 2 remained neurologically normal during the following 3 years.Case 3 subsequently developed refractory epilepsy and was found with hippocampal sclerosis in MRI after 1.5 years. Conclusions Hypertension and ALL induction chemotherapy regimens comprised the main predisposing factors for PRES in these cases.There is a high rate of convulsions incidence in children.PRES is not fully reversible, SE and NCSE during acute stage will cause sequelae and refractory epilepsy.High-dose steroids may trigger PRES, which should be used with caution in treatment of PRES. Key words: Posterior reversible encephalopathy syndrome; Magnetic resonance imaging; Electroencephalogram; Treatment; Clinical manifestation; Child