Clinical and cranial imaging features of posterior reversible encephalopathy syndrome in children

Abstract

Objective To investigate the clinical and cranial imaging features of posterior reversible encephalopathy syndrome (PRES) in children. Method Seven cases of PRES in children were retrospectively analyzed. Results The underlying diseases were autoimmune diseases(4 cases), renal diseases(2 cases) and Blau syndrome(1 case), respectively.There were 6 cases had been treated with the cytotoxic drugs and 3 cases of secondary hypertension.The main manifestations included seizures(7 cases), hypertension(7 cases), headache and vomiting(4 cases), conscious disturbance(4 cases), visual disorder(3 cases), body movement dysfunction(1 case). Five cases recovered after a few days, 1 case had cognitive impairment and 1 case died in the end.But 2 cases recurred after a few days.Magnetic resonance imaging (MRI) demonstrated multiple lesions located in bilateral parietal occipital lobes(7 cases), frontal lobes (3 cases), insular lobes(2 cases), temporal lobe(2 cases), hippocamp (2 cases), thalamus (2 cases), callosum (2 cases) and bilateral basal ganglia (1 case). The lesions were prominent in gray matter and subcortical white matter.Lesions of 6 cases appeared as hyperintense signal on T1 weighted (T1W)images, T2 weighted (T2W)images and fluid-attenuated inversion-recovery(FLAIR) images, isointense on diffusion weighted imaging (DWI), but 1 case had isointense signal on T1W images, hyperintense signal on T2W and FLAIR images, mildly hypointense signalon on DWI.MRI in 4 cases were reexamined in 8 days, and 3 cases of focus disappeared mostly, 1 case unchanged, but slight reduction and encephalanalosis after 3 months follow-up. Conclusions PRES in children has various characteristic clinical and neuroradiological features and not all the patients can recover completely.Early diagnosis and effective treatment may be essential to prevent progression of irreversible brain damage. Key words: Posterior reversible encephalopathy syndrome; Clinical feature; Magnetic resonance imaging