Guirola Ricardo, Hunter Jill V, Perez Maria, Muscal Eyal
1Baylor College of Medicine and Pediatric Rheumatology Center, Texas Children's Hospital, Houston, TX, USA.
J Child Neurol. 2014 Jan;29(1):103-7. doi: 10.1177/0883073812465339. Epub 2012 Nov 15.
Polyarteritis nodosa is a systemic necrotizing vasculitis involving medium-sized muscular arteries. Polyneuropathy is the only neurologic manifestation included in the pediatric classification schema. Central nervous system manifestations include infarction, hemorrhage, and encephalitis. We report on a 13-year-old female whose initial presentation of polyarteritis nodosa included hypertension, seizures, and neuroimaging findings of vasogenic edema and posterior reversible encephalopathy syndrome. Posterior reversible encephalopathy syndrome has been reported in association with renal disease, transplantation, autoimmunity, and cytotoxic medications. Posterior reversible encephalopathy syndrome outcomes are usually favorable with supportive care and treatment of the underlying etiology. The patient's neurologic condition improved after treatment of hypertension. Hypertension, posterior reversible encephalopathy syndrome, and abdominal pain led to a diagnostic workup. A systemic vasculitis was confirmed after detection of a perinephric hematoma and intrarenal aneurysms. This is a novel case of posterior reversible encephalopathy syndrome as an initial manifestation of pediatric polyarteritis nodosa.
结节性多动脉炎是一种累及中等大小肌性动脉的系统性坏死性血管炎。多发性神经病是儿科分类方案中唯一包含的神经学表现。中枢神经系统表现包括梗死、出血和脑炎。我们报告了一名13岁女性，其结节性多动脉炎的初始表现包括高血压、癫痫发作以及血管源性水肿和后部可逆性脑病综合征的神经影像学表现。后部可逆性脑病综合征已被报道与肾脏疾病、移植、自身免疫和细胞毒性药物有关。通过支持治疗和对潜在病因的治疗，后部可逆性脑病综合征的预后通常良好。患者的神经状况在高血压得到治疗后有所改善。高血压、后部可逆性脑病综合征和腹痛导致了诊断性检查。在检测到肾周血肿和肾内动脉瘤后，确诊为系统性血管炎。这是一例以后部可逆性脑病综合征为儿科结节性多动脉炎初始表现的新病例。
