Gephart Melanie G Hayden, Taft Bonnie P, Giese Anne-Katrin, Guzman Raphael, Edwards Michael S B
Department of Neurosurgery, Stanford University Hospital and Clinics, Stanford, California 94305-5327, USA.
J Neurosurg Pediatr. 2011 Mar;7(3):235-7. doi: 10.3171/2010.12.PEDS10299.
Posterior reversible encephalopathy syndrome (PRES) has been described in pediatric neurooncology patients, although it has not been documented perioperatively in pediatric neurosurgery patients not actively receiving chemotherapy. Recently at the authors' facility, 2 cases of PRES were diagnosed perioperatively in children with brainstem ependymoma. Both patients had presented with hypertension, altered mental status, and seizures and demonstrated MR imaging features consistent with PRES. The patients were treated with antiseizure and antihypertension medications, leading to improvement in both clinical symptoms and neuroimaging findings. These cases are the first to document PRES in perioperative pediatric neurosurgery patients not actively receiving chemotherapy. Both patients had ependymoma involving the brainstem, which may have led to intra- and perioperative hemodynamic instability (including hypertension) and predisposed them to this syndrome. An awareness of PRES in similar scenarios will aid in the prevention, diagnosis, and treatment of pediatric neurosurgery patients with this syndrome.
小儿神经肿瘤患者中已描述过后可逆性脑病综合征（PRES），尽管在未积极接受化疗的小儿神经外科手术患者围手术期尚未有相关记录。最近在作者所在机构，2例脑干室管膜瘤患儿在围手术期被诊断为PRES。两名患者均出现高血压、精神状态改变和癫痫发作，磁共振成像（MR）特征与PRES相符。患者接受了抗癫痫和抗高血压药物治疗，临床症状和神经影像学表现均有所改善。这些病例是首次记录未积极接受化疗的小儿神经外科手术患者围手术期出现PRES。两名患者均患有累及脑干的室管膜瘤，这可能导致术中和围手术期血流动力学不稳定（包括高血压），并使他们易患此综合征。在类似情况下认识到PRES将有助于预防、诊断和治疗患有该综合征的小儿神经外科手术患者。
