Behera Chinmay K, Jain Mukesh K, Mishra Reshmi, Jena Pratap K, Dash Santosh K, Sahoo Ranjan K
Department of Paediatrics, Kalinga Institute of Medical Sciences, Bhubaneswar, Odisha, India.
Department of Public Health, Kalinga Institute of Industrial Technology, Bhubaneswar, Odisha, India.
Indian J Crit Care Med. 2020 Dec;24(12):1223-1229. doi: 10.5005/jp-journals-10071-23680.
Posterior reversible encephalopathy syndrome (PRES) is a clinico-radiographic entity of heterogeneous etiologies having similar clinical and neuroimaging features. Pediatric data are sparse, making early diagnosis challenging, which needs a high index of suspicion. So, we conducted this study to evaluate clinico-radiological features, associated risk factors, etiology, and outcome in children.
This is a retrospective case series of patients, diagnosed as having PRES and followed up at a tertiary care hospital in Eastern India between September 2016 and December 2019.
Among 16 patients with a median age of 9.5 years [interquartile range (IQR) 8-13.75] and a male preponderance (75%), common underlying diseases were post-streptococcal glomerulonephritis (56.3%) and renovascular hypertension (12.5%). Acute elevation of blood pressure was found in all patients ( = 16). The neurological symptom was seizure (87.5%), mental changes (68.75%), headache (43.8%), vomiting (31.3%), and visual disturbances (31.3%). The most common triggering factor was hypertension (100%), use of mycophenolate mofetil and prednisolone (12.5%), and hemodialysis (12.5%). Anemia was present in 15 (93.4%) patients at the time of admission. All showed abnormal neuroimaging with 55% having atypical involvement. The most common site was the parietal-occipital cortex (88%), frontal and temporal lobe (44% cases each), and the cerebellum (13%). Clinical recovery was followed by a radiological resolution in all survived except in one, who developed visual impairment.
Posterior reversible encephalopathy syndrome should be considered in the differential diagnosis of patients who present with acute neurological disturbances and underlying diseases such as renal disorders, vasculitis, malignancy, and use of immunosuppressant accompanied by hypertension. Early diagnosis and treatment of comorbid conditions are of paramount importance for the early reversal of the syndrome.
Behera CK, Jain MK, Mishra R, Jena PK, Dash SK, Sahoo RK. Clinico-radiological Profile of Posterior Reversible Encephalopathy Syndrome and Its Associated Risk Factors in PICU: A Single-center Experience from a Tertiary Care Hospital in Bhubaneswar, Odisha. Indian J Crit Care Med 2020;24(12):1223-1229.
后部可逆性脑病综合征（PRES）是一种病因各异但具有相似临床和神经影像学特征的临床-放射学实体。儿科相关数据稀少，使得早期诊断具有挑战性，这需要高度的怀疑指数。因此，我们开展了这项研究以评估儿童PRES的临床-放射学特征、相关危险因素、病因及预后。
这是一项回顾性病例系列研究，研究对象为2016年9月至2019年12月期间在印度东部一家三级医疗中心被诊断为PRES并接受随访的患者。
16例患者的中位年龄为9.5岁[四分位间距（IQR）8 - 13.75]，男性占多数（75%），常见基础疾病为链球菌感染后肾小球肾炎（56.3%）和肾血管性高血压（12.5%）。所有患者（n = 16）均出现血压急性升高。神经系统症状包括癫痫发作（87.5%）、精神改变（68.75%）、头痛（43.8%）、呕吐（31.3%）和视觉障碍（31.3%）。最常见的触发因素是高血压（100%）、使用霉酚酸酯和泼尼松龙（12.5%）以及血液透析（12.5%）。15例（93.4%）患者入院时存在贫血。所有患者神经影像学均异常，55%为非典型受累。最常见的部位是顶枕叶皮质（88%）、额叶和颞叶（各44%）以及小脑（13%）。除1例出现视力损害外，所有存活患者临床恢复后神经影像学表现均有改善。
对于出现急性神经功能障碍且伴有肾脏疾病、血管炎、恶性肿瘤等基础疾病以及使用免疫抑制剂并伴有高血压的患者，鉴别诊断时应考虑后部可逆性脑病综合征。早期诊断和治疗合并症对于该综合征的早期逆转至关重要。
Behera CK, Jain MK, Mishra R, Jena PK, Dash SK, Sahoo RK. 儿科重症监护病房后部可逆性脑病综合征的临床-放射学特征及其相关危险因素：来自奥里萨邦布巴内斯瓦尔一家三级医疗中心的单中心经验。《印度重症医学杂志》2020;24(12):1223 - 1229。
