Abstract
Introduction:The posterior reversible encephalopathy (PRES) syndrome encompasses a set of clinical-radiological findings associated with severe systemic arterial hypertension. This case report proposes to discuss the identification, diagnosis, and management of PRES in the pediatric population.Case presentation:Female patient, 10 years old, admitted to the emergency room with complaint of oliguria and generalized edema. At the initial physical exam, the only alteration present was anasarca. The diagnostic investigation revealed nephrotic syndrome, and clinical treatment was started. She evolved on the 8th day of hospitalization with peak hypertension, sudden visual loss, reduced level of consciousness, nystagmus, and focal seizures requiring intubation. She was transferred to the Intensive Care Unit, with neurological improvement, after the established therapy. CT scan revealed a discrete hypodense area in the white matter of the occipital lobe and anteroposterior groove asymmetry, compatible with PRES.Discussion:PRES is due to vasogenic cerebral edema of acute or subacute installation. Symptoms include headache and altered consciousness, stupor, coma, neurological deficits, seizures and cortical blindness. Nephropathies are the main cause of PRES in pediatrics. Magnetic resonance imaging with diffusion of molecules is the gold standard for diagnosis. The initial treatment objectives are the reduction of blood pressure, antiepileptic therapy, correction of hydroelectrolytic and acid-base disorders and management of intracranial hypertension.Conclusion:PRES is associated with acute hypertension. Early diagnosis and proper management may determine a better prognosis and minimize the severity of the clinical course.
Highlights
The posterior reversible encephalopathy (PRES) syndrome encompasses a set of clinical-radiological findings associated with severe systemic arterial hypertension
The posterior reversible encephalopathy syndrome (PRES) involves a set of clinical and radiological findings characterized by a variable spectrum in severity of headache, nausea, vomiting, visual disturbances, focal neurological deficits, and seizures associated with severe systemic arterial hypertension[1]
She was transferred on that day in a mobile intensive care unit (ICU) to a hospital equipped with a pediatric ICU
Summary
The posterior reversible encephalopathy syndrome (PRES) involves a set of clinical and radiological findings characterized by a variable spectrum in severity of headache, nausea, vomiting, visual disturbances, focal neurological deficits, and seizures associated with severe systemic arterial hypertension[1]. The initial exams identified significant hypoalbuminemia (2.1 g/dL), proteinuria (4 + / 4+), absence of azotemia (urea 36 mg/dL and creatinine 0.55 mg/dL), normal hemogram, negative anti-streptolysin O antibodies, and C-reactive protein of 3.0 mg/L. She was hospitalized with a diagnostic hypothesis of decompensated glomerulopathy, probably triggered by a nonspecific viral infection. There was hemodynamic and neurological stabilization, with reduction of blood pressurewithout the need for intravenous vasodilators and other antiepileptic drugs She was transferred on that day in a mobile ICU to a hospital equipped with a pediatric ICU. Computed tomography performed there revealed an area of discrete hypodensity, suggestive of edema, in the white matter of the occipital lobe and anteroposterior groove asymmetry, compatible with PRES syndrome
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