Posterior reversible encephalopathy syndrome in a child with Guillian-Barré syndrome

Abstract

Posterior reversible encephalopathy syndrome (PRES) (synonym: reversible posterior leukoencephalopathy syndrome, reversible posterior cerebral edema syndrome) is a neurotoxic state associated with sudden elevation in blood pres- sure. It presents initially with lethargy and somnolence but can also manifest as headache, confusion, hemianopsia, nausea vomiting, seizures, vision disturbance, paresis, and cortical blindness. Very often these features are short lived and are resolved both clinically and radiologically but occasionally this disease can progress to coma and other devastating permanent complica- tions. Several etiological factors have been described in literature including hypertensive encephalopathy, preeclampsia, eclamp- sia, infection, immunosuppression, autoimmune diseases, cyclosporine toxicity, drug overdose, trauma with aortic dissection, pheochromocytoma and Guillain-Barre syndrome (GBS). Particularly, very few cases have been reported in literature indicating GBS as a precipitating factor for PRES. Therefore, we present here a brief review of literature describing association between GBS and PRES along with detailed diagnostic and therapeutic description. This review suggests necessity for adequate clinical suspicion for PRES in GBS afflicted patient followed by prompt diagnostic and therapeutic intervention. Failure to treat promptly and adequately might lead to the catastrophic consequence both in terms of morbidity and mortality.