Carvalho Eve Grillo, Peluso Henrique Guarino Colli, Batista Lorena Luana, Moreira Cissa Santos, Protti Juliana Suzano Moraes, Soares Maria Cristina Bento, Autran Aline de Freitas Suassuna, Almeida Amanda Rocha Soares, Rodrigues Denise Cristina, Bernardes Lívia Verônica Grillo Romano, Paula Luciana Pimenta de
Universidade Federal de Viçosa, Departamento de Medicina e Enfermagem (DEM), Viçosa, MG, Brasil.
J Bras Nefrol. 2019 Jul-Sep;41(3):436-439. doi: 10.1590/2175-8239-JBN-2018-0111. Epub 2018 Sep 21.
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.
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.
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.
PRES is associated with acute hypertension. Early diagnosis and proper management may determine a better prognosis and minimize the severity of the clinical course.
后部可逆性脑病（PRES）综合征包括一组与严重系统性动脉高血压相关的临床 - 放射学表现。本病例报告旨在讨论儿科人群中PRES的识别、诊断和管理。
一名10岁女性患者因少尿和全身水肿主诉入住急诊室。初次体格检查时，唯一的改变是全身水肿。诊断性检查显示为肾病综合征，并开始了临床治疗。她在住院第8天病情进展，出现高血压峰值、突然视力丧失、意识水平下降、眼球震颤和局灶性癫痫发作，需要插管。经既定治疗后，她被转入重症监护病房，神经功能有所改善。CT扫描显示枕叶白质有一个离散的低密度区以及前后沟不对称，符合PRES表现。
PRES是由急性或亚急性发生的血管源性脑水肿引起的。症状包括头痛、意识改变、昏睡、昏迷、神经功能缺损、癫痫发作和皮质盲。肾病是儿科PRES的主要原因。分子扩散磁共振成像是诊断的金标准。初始治疗目标是降低血压、抗癫痫治疗、纠正水电解质和酸碱紊乱以及处理颅内高压。
PRES与急性高血压相关。早期诊断和恰当管理可决定更好的预后并使临床病程的严重程度降至最低。
