Posterior reversible encephalopathy syndrome following post-streptococcal glomerulonephritis

Carlos Jesus Pereira Haygert,Giordano Rafael Tronco Alves,Isadora Cristina Olesiak Cordenonsi,Régis Vinícius De Andrade Silva

doi:10.3329/bjms.v12i3.13323

Abstract

Posterior reversible encephalopathy syndrome (PRES) comprises a unique pattern of brain vasogenic edema that is seen in the setting of a neurotoxic status. Besides many etiologies have been already associated with PRES development, such as chronic renal disease, use of chemotherapy agents and inflammatory conditions, the imaging features are very suggestive and helpful for an appropriate diagnosis. We report here a case of PRES secondary to post-streptococcal glomerulonephritis (PSGN), which evolved successfully after clinical management. An 11-year-old boy was admitted with a typical history and findings of PSGN, associated with sensory alterations, headache and recent tonic-clonic seizure. Computed tomography (CT) scan of the head has revealed bilateral and symmetric hypodense areas, remarkably located at posterior cerebral regions, indicating PRES. Patient received support therapy with diuretics, and antibiotics prescription after discharge. At ambulatory follow-ups, the patient remains asymptomatic, with complete clinical and radiological improvement.Bangladesh Journal of Medical Science Vol. 12 No. 03 July 13 Page 341-343 DOI: http://dx.doi.org/10.3329/bjms.v12i3.13323

Highlights

Posterior reversible encephalopathy syndrome (PRES) is defined as the occurrence of diffuse brain swelling, most often at posterior cerebral areas, in response to a neurotoxic status that may be secondary to various disorders[1]
Acute glomerulonephritis can course with nephrotic syndrome followed by PRES
PRES is an infrequent entity, which is characterized by a diffuse cerebral edema secondary to neurotoxicity

Summary

Introduction

Posterior reversible encephalopathy syndrome (PRES) is defined as the occurrence of diffuse brain swelling, most often at posterior cerebral areas, in response to a neurotoxic status that may be secondary to various disorders[1]. The alterations of PRES are potentially reversible after the background cause management. If recognition of PRES is delayed, or base condition is mistreated, neurological sequelae or even death may occur. The authors report hereby a successfully conducted case of post-streptococcal glomerulonephritis (PSGN), which presented PRES as a life-threatening complication. Case presentation: An 11-year-old boy has been admitted at the pediatric care unit presenting progressive sensory alterations for a week, culminating with a tonic-clonic seizure of recent onset. His parents reported that approximately three weeks ago he was treated for an upper airway infection with antibiotics, and remained asymptomatic until last week. No signs of fever and focal neurological changes were detected

Laboratorial tests performances have consistently

Discussion

Findings

Patterns and Lesion Distribution in Posterior