Abstract
Posterior reversible encephalopathy syndrome (PRES) is a novel clinicoradiological syndrome characterized by convulsions, headache, altered mentality, and impaired vision, which are usually accompanied by hypertension. As its nomination, PRES is usually diagnosed according to the presence of typical neuroimage showing vasogenic edema predominately involving the posterior brain area. With the widespread utilization of magnetic resonance imaging (MRI), PRES is becoming more perceptible in different medical fields. Compared to adult cases, childhood PRES seems to have a broader clinical and neuroradiological spectrum. PRES can be associated with various underlying comorbidities, medication use, and therapeutic modalities in children with diverse neurological manifestations. Moreover, pediatric patients with PRES have a more significant propensity for atypical MRI findings beyond the typically posterior cerebral areas. The knowledge of typical and atypical presentations in children is essential to avoid misdiagnosing or missing PRES, which is a potentially treatable entity. Early supportive care is the mainstay of treatment, with particular attention to the treatment of hypertension with rigorous attention to all body systems. Prompt identification and symptom-directed management are imperative to achieve a reversible prognosis in childhood PRES. Future studies specially designed for the child population are required to determine potential outcome predictors, and further, to develop novel strategies of neuroprotection in childhood PRES.
Highlights
Posterior reversible encephalopathy syndrome (PRES), initially reported from 15 adult patients by Hinchey et al [1], is a well-recognized entity characterized by a combination of clinical and radiological features
Another intriguing hypothesis of the pathomechanism for PRES-associated cerebral edematous change addresses the role of vascular endothelial growth factor (VEGF), which is involved in regulating the permeability of the endothelial barrier
The complication of cerebral infarction, which is present at the acute phase of PRES in about 10-23% of patients with available diffusionweighted imaging (DWI), is among the early signs of irreversible damage associated with unfavorable outcomes [4]
Summary
Posterior reversible encephalopathy syndrome (PRES), initially reported from 15 adult patients by Hinchey et al [1], is a well-recognized entity characterized by a combination of clinical and radiological features. This conditionally induced neurological disorder has been indicated by different terms, including reversible posterior leukoencephalopathy syndrome, reversible occipitalparietal encephalopathy, and reversible posterior cerebral edema syndrome. After its initial description in 1996, the identification of PRES induced by various etiologies has shown exponential growth over the past few decades These reports are in the form of single case reports, case series, broad-scale retrospective researches, and meta-analysis systemic reviews from large institutions.
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