Posterior Reversible Encephalopathy Syndrome (Pres) Presenting with Status Epilepticus in the Context of Post-Streptococcal Glomerulonephritis

Abstract

Background: PRES is an increasingly recognized cliniconeuroradiological disorder, presenting with headache, nausea, vomiting, seizures, altered consciousness and visual disturbances. It is mainly associated with kidney disease, organ transplantation, immunosuppressives, autoimmune diseases and eclampsia. Typical MRI findings include white matter vasogenic edema predominantly affecting the posterior parietaloccipital lobes of the brain. The symptoms may persist for several days and the radiological findings resolve within few weeks. Case-diagnosis/treatment: We report a previously healthy 7-year old patient, who presented with status epilepticus, following a 2-day history of nausea, vomiting and headache. The patient was apyrexial and had no history of epilepsy or recent history of head trauma or ingestion of toxic substances. During the seizures, raised systolic blood pressure was recorded. Periorbital edema and proteinuria were noted for 24 hours post-seizure. Persistent microscopic hematuria and hypertension were also recognized. Based on a positive personal history of tonsillitis 2 weeks before the onset of the seizures, persistent microscopic hematuria, raised blood pressure for one week, low C3 and C4 levels, raised Antistreptolysin O titer and typical MRI findings that resolved 4 weeks later, PRES was diagnosed in the context of post-streptococcal glomerulonephritis. Conclusions: PRES should always be considered in patients with glomerulonephritis presenting with acute hypertension and rapidly progressive neurological manifestations. Since it is often unsuspected, prompt recognition and treatment is important for the resolution of the symptoms and radiological features, as well as for preventing unnecessary investigations and therapies.