Donmez F Y, Guleryuz P, Agildere M
Department of Radiology, Baskent University Faculty of Medicine, 44. Sokak No: 11/8, Bahcelievler, Ankara, Turkey.
Clin Neuroradiol. 2016 Jun;26(2):209-13. doi: 10.1007/s00062-014-0350-2. Epub 2014 Oct 8.
Posterior reversible encephalopathy syndrome (PRES) is a clinical scenario with convulsion, vision abnormalities, altered mental status, and headaches in the presence of an underlying etiology, and the diagnosis can be made by support of radiological studies. In this study, we evaluated the magnetic resonance imaging (MRI) findings of PRES in children and compared our findings with that of the known features in adults, and reviewed the possible pathophysiological reasons that may cause the difference.
A total of 29 children (13 male, 16 female, aged 1-17 years, mean age: 10 years) diagnosed as having PRES were retrospectively reviewed. Clinical records were analyzed for the clinical symptoms and the underlying etiology. MR images were evaluated for the distribution of lesions, contrast enhancement, diffusion restriction, and hemorrhage.
Presenting symptoms and underlying etiologies were variable. Frontal lobe (66 %) edema was almost as common as parietal and occipital involvement. Cerebellar involvement was present in almost half of the patients (48 %), which was more frequent than in the adult patients. Contrast enhancement is another finding that was found to be more common in children than in the adults (39 %). Four patients had diffusion restriction (15 %) and four patients had hemorrhage (%15), which are almost the same frequency as in the adults.
The increased incidence of cerebellar involvement may show that the posterior circulation in children is more vulnerable than the adults. The contrast enhancement in children, which is seen more commonly than in the adults, may show that the pathophysiology in children may be more commonly related to blood-brain barrier breakdown, which can support the theory of the toxic endothelial injury.
后部可逆性脑病综合征（PRES）是一种在存在潜在病因时出现惊厥、视觉异常、精神状态改变和头痛的临床情况，其诊断可通过影像学检查来支持。在本研究中，我们评估了儿童PRES的磁共振成像（MRI）表现，并将我们的发现与成人已知特征进行比较，同时回顾了可能导致差异的病理生理原因。
对29例诊断为PRES的儿童（男13例，女16例，年龄1 - 17岁，平均年龄：10岁）进行回顾性研究。分析临床记录中的临床症状和潜在病因。对MR图像评估病变分布、对比增强、扩散受限和出血情况。
呈现的症状和潜在病因各不相同。额叶水肿（66%）几乎与顶叶和枕叶受累一样常见。近一半患者（48%）存在小脑受累，这比成人患者更常见。对比增强是另一个在儿童中比成人更常见的表现（39%）。4例患者有扩散受限（15%）且4例患者有出血（15%），其发生率与成人几乎相同。
小脑受累发生率增加可能表明儿童的后循环比成人更易受损。儿童中对比增强比成人更常见，这可能表明儿童的病理生理机制可能更常与血脑屏障破坏有关，这支持了毒性内皮损伤理论。
