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Nada MG, Libda YI, Gohary MM, Dessouky R. Pediatric posterior reversible encephalopathy syndrome: Can MR imaging features predict outcomes in non-oncologic patients? Eur J Radiol 2024; 170:111214. [PMID: 38007856 DOI: 10.1016/j.ejrad.2023.111214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Revised: 08/09/2023] [Accepted: 11/20/2023] [Indexed: 11/28/2023]
Abstract
PURPOSE Identify MR features predictive of poor outcomes in non-oncologic pediatric PRES. METHOD A six-year search of all non-oncologic pediatric patients with clinical and MR features of PRES was performed. Modified Rankin scores were used to classify clinical outcomes into good versus poor, then clinical and MR features were compared among groups. Univariate and multivariate analysis was performed to identify MR predictors of poor outcomes for various imaging features, and p-values < 0.05 were considered statistically significant. RESULTS One hundred and forty-one patients (mean age 10.1 ± 3.0 years, male to female ratio 1:1.1) were included. Clinically, nephrotic syndrome (p = 0.03), focal deficits (p = 0.04), longer hospitalization (p < 0.001), and mechanical ventilation (p < 0.001) were significantly associated with poor outcomes. Univariate analysis revealed that deep grey matter nuclei (OR = 5.29, 95 % CI: 1.6-18.0) and cerebellar edema patterns (OR = 3.49, 95 % CI: 1.3-9.5), cytotoxic edema (OR = 63.6, 95 % CI:16.5-244.2), hemorrhage (OR = 16.58, 95 % CI: 4.3-64.2), and severe PRES patterns (OR = 11.0, 95 % CI: 3.5-34.7) on MR were all significantly associated with poor outcomes (p-values = 0.008 and 0.014, <0.001, <0.001, and < 0.001, respectively). This remained true for cytotoxic edema (OR = 84.26, 95 % CI: 17.3-410.9, p-value < 0.001) and hemorrhage (OR = 44.56, 95 % CI: 6.9-289.7, p-value < 0.001) on multivariate analysis. CONCLUSION Diffusion restriction and hemorrhage on initial MR scans were the two independent predictors of poor outcomes in non-oncologic pediatric patients.
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Affiliation(s)
- Mohamad Gamal Nada
- Radiology Department, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt
| | - Yasmin Ibrahim Libda
- Radiology Department, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt
| | - Mahmoud M Gohary
- Pediatric Department, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt
| | - Riham Dessouky
- Radiology Department, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt.
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2
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Traore WYM, Diallo ID, Yassin MR, El Haddad S, Chat L, Allali N. Posterior Reversible Encephalopathy Syndrome: A Complication of Acute Renal Failure in a Child. Glob Pediatr Health 2023; 10:2333794X231210609. [PMID: 38024469 PMCID: PMC10676056 DOI: 10.1177/2333794x231210609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 10/08/2023] [Accepted: 10/11/2023] [Indexed: 12/01/2023] Open
Abstract
Posterior reversible encephalopathy syndrome (PRES) is a clinico-radiological entity occurring during several conditions and more frequently in those associated with severe hypertension. The diagnostic approach is possible by considering the clinical context and MRI data, where white matter abnormalities are observed predominantly in the parietal and occipital territories secondary to the formation of a vasogenic edema. The evolution is characterized by a reversibility of the lesions in case of early diagnosis and management. The authors report a case of reversible posterior encephalopathy in a 12-year-old child who presented with a status epilepticus, revealing an acute renal failure.
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Munirah MP, Mohamad N, Norhayati MN, Nurul Azman A. Posterior reversible encephalopathy syndrome: A conundrum of nephrotic syndrome complication. ELECTRONIC JOURNAL OF GENERAL MEDICINE 2023. [DOI: 10.29333/ejgm/12835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Nephrotic syndrome is a kidney disease with proteinuria, hypoalbuminemia, and edema. One rare, potentially life-threatening complication of nephrotic syndrome is posterior reversible encephalopathy syndrome (PRES). Sudden episodes of neurological symptoms such as headache, confusion, seizures, or focal neurological deficits with radiological findings of white matter abnormalities in the parietal and occipital lobes characterize it. Multiple factors predispose an individual with nephrotic syndrome to PRES, such as uncontrolled hypertension, reduced serum albumin levels, administration of drugs (cyclosporine, tacrolimus), anasarca, disturbed body fluid status and renal insufficiency. Here, we report a case of PRES in a seven-year-old girl with nephrotic syndrome who presented with high blood pressure while admitted to the ward. Her neurological symptom rapidly recovered after the control of hypertension. Recurrence of acute severe hypertension, nephrotic state (edema/ hypoalbuminemia), and renal insufficiency may lead to recurrent PRES. Thus, early treatment of trigger factors, especially of hypertension, is vital to reduce the episodes of PRES.
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Affiliation(s)
- Mohd Puad Munirah
- Department of Family Medicine, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian, Kelantan, MALAYSIA
| | - Noraini Mohamad
- School of Dental Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian, Kelantan, MALAYSIA
| | - Mohd Noor Norhayati
- Department of Family Medicine, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian, Kelantan, MALAYSIA
| | - Azzahra Nurul Azman
- Department of Radiology, Hospital Raja Permaisuri Bainun, Ipoh, Perak, MALAYSIA
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4
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El Hage S, Akiki D, Khalife L, Assaf E, Jaoude MA. Rapid clinical recovery of posterior reversible encephalopathy syndrome in two cases of IgA nephropathy disease and nephrotic syndrome type 9 post-renal transplant. Transpl Immunol 2021; 68:101450. [PMID: 34391883 DOI: 10.1016/j.trim.2021.101450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Revised: 08/09/2021] [Accepted: 08/10/2021] [Indexed: 11/28/2022]
Abstract
Posterior reversible encephalopathy syndrome (PRES) is a clinical-radiological syndrome often associated with immunosuppressant drug use, renal disease, and eclampsia and characterized by parieto-occipital vasogenic edema that usually resolves within days. Globally and in the settings of renal transplant, literature concerning PRES is very scattered. In this report, we provide two cases, one diagnosed with IgA nephropathy and another with nephrotic syndrome type 9 that developed episodes of tonic-clonic seizure immediately after renal transplant in case 1 and four days post-transplant in case 2. The two patients had a history of hypertension, renal disease, corticosteroid and immunosuppressant drug use. Neuro-imaging showed typical vasogenic edema involving the parieto-occipital areas. Therefore, the clinical-radiological presentation confirmed the diagnosis of PRES in both cases. Also, rapid neurologic recovery was witnessed upon administration of anti-epileptic and anti-hypertensive medications. Non-discontinuation of immunosuppressants, steroids, early symptomatic management, and blood pressure control are favorable factors that might explain the rapid recovery of these two patients.
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Affiliation(s)
- Said El Hage
- Lebanese University, Faculty of Medical Sciences, Department of Medicine, Beirut, Lebanon; Lebanese University, Faculty of Medical Sciences, Neuroscience Research Center, Beirut, Lebanon; Institut National de Santé Publique, Epidémiologie Clinique et Toxicologie, Sector of Public Health and Epidemiology, Department of Public Health, Beirut, Lebanon
| | - Dany Akiki
- Lebanese University, Faculty of Medical Sciences, Department of Medicine, Beirut, Lebanon.
| | - Lourdes Khalife
- Department of Neurology, Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon
| | - Elie Assaf
- Department of Neurology, Middle East Institute of Health, Bsalim, Lebanon
| | - Maroun Abou Jaoude
- Transplantation Unit, Department of General Surgery, Middle East Institute of Health, Bsalim, Lebanon; Department of General Surgery, Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon
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5
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Nassar N, Chater C, Chelala A. Posterior reversible encephalopathy syndrome associated with focal segmental glomerulosclerosis in a child. BMJ Case Rep 2021; 14:14/4/e240085. [PMID: 33853815 PMCID: PMC8054056 DOI: 10.1136/bcr-2020-240085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Posterior reversible encephalopathy syndrome (PRES) is a rare neurological entity, typically manifested by reversible oedema in the parieto-occipital lobes. It is usually associated with primary hypertension, autoimmune diseases and immunosuppressants. Renal disease is an uncommon cause of PRES. We report a case of an 11-year-old boy with STimulator of INterferon Genes-associated vasculopathy with onset in infancy complicated by focal segmental glomerulosclerosis leading to hypertension and PRES. The patient presented with headache, acute bilateral visual loss and hypertension. Brain MRI showed atypical features revealed by parieto-occipital haemorrhage. The child improved few days after antihypertensive therapy. Follow-up MRI showed complete resolution of haemorrhage. It is important to keep high index of suspicion for the uncommon association of PRES with underlying kidney disease with or without immunosuppressive agents. This combination is the first to our knowledge to be described in paediatric population. Atypical MRI features such as haemorrhage should be kept in mind. Symptoms are reversible within days to weeks with early diagnosis and treatment.
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Affiliation(s)
- Nadine Nassar
- Department of Radiology, Notre Dame des Secours University Hospital Center, Jbeil, Mont-Liban, Lebanon.,Faculty of Medicine and Medical Sciences, Holy Spirit University of Kaslik, Jounieh, Lebanon
| | - Charbel Chater
- Faculty of Medicine and Medical Sciences, Holy Spirit University of Kaslik, Jounieh, Lebanon .,Department of General Surgery, Notre Dame des Secours University Hospital Center, Jbeil, Mont-Liban, Lebanon
| | - Amal Chelala
- Department of Radiology, Notre Dame des Secours University Hospital Center, Jbeil, Mont-Liban, Lebanon.,Faculty of Medicine and Medical Sciences, Holy Spirit University of Kaslik, Jounieh, Lebanon
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6
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Keller T, Wille D, Laube GF. Pathophysiological aspects of posterior reversible encephalopathy syndrome in two peritoneal-dialyzed children. Clin Case Rep 2021; 9:260-265. [PMID: 33505689 PMCID: PMC7813126 DOI: 10.1002/ccr3.3510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 09/02/2020] [Accepted: 09/08/2020] [Indexed: 11/09/2022] Open
Abstract
Hypotension, blood pressure fluctuation, and endothelial impairment indicate possible additive pathophysiological aspects in the development of posterior reversible encephalopathy syndrome in children on peritoneal dialysis.
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Affiliation(s)
- Tamara Keller
- Nephrology UnitUniversity Children’s Hospital ZurichZurichSwitzerland
| | - David‐Alexander Wille
- Department of Pediatric NeurologyUniversity Children’s Hospital ZurichZurichSwitzerland
| | - Guido F. Laube
- Nephrology UnitUniversity Children’s Hospital ZurichZurichSwitzerland
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7
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Ronnie T, Beyerlein L, Murati M, Louie JP. A PRESing case of visual changes and confusion. Am J Emerg Med 2019; 38:411.e1-411.e3. [PMID: 31784391 DOI: 10.1016/j.ajem.2019.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Accepted: 09/24/2019] [Indexed: 11/15/2022] Open
Abstract
Visual disturbances are an uncommon pediatric chief complaint. Usually, after a complete ocular exam including visual acuity, most causes are benign and not life-threatening. Children with abnormal visual complaints who have underlying medical conditions, such as SLE or other autoimmune conditions, a recipient of a transplant, renal disease, and even eclampsia require closer scrutiny. We report a 10-year-old female with a history of systemic lupus erythematosus complicated by hypertension and cardiomyopathy secondary to lupus who presented to the emergency department with a history of vision loss and headache. Head computer tomography demonstrated findings of posterior reversible encephalopathy syndrome (PRES). PRES is a clinical disease associated with cranial radiological findings of heterogenous etiologies that is often reversible. Prompt recognition and treatment are important in preventing permanent damage, long term morbidity and even death.
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Affiliation(s)
- Tanisha Ronnie
- University of Minnesota School of Medicine, 420 Delaware Street SE, Minneapolis, MN 55455, United States.
| | - Larrisa Beyerlein
- University of Minnesota, Department of Pediatrics, 2450 Riverside Avenue, Minneapolis, MN 55454, United States.
| | - Michael Murati
- University of Minnesota, Department of Radiology, 420 Delaware Street SE, Minneapolis, MN 55455, United States.
| | - Jeffrey P Louie
- University of Minnesota, Department of Pediatrics, 2450 Riverside Avenue, Minneapolis, MN 55454, United States.
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8
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Seeman T, Hamdani G, Mitsnefes M. Hypertensive crisis in children and adolescents. Pediatr Nephrol 2019; 34:2523-2537. [PMID: 30276533 DOI: 10.1007/s00467-018-4092-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 09/17/2018] [Accepted: 09/18/2018] [Indexed: 12/28/2022]
Abstract
Hypertensive crisis is a relatively rare condition in children. However, if not treated, it might be life-threatening and lead to irreversible damage of vital organs. Clinical presentation of patients with hypertensive crisis can vary from very mild (hypertensive urgency) to severe symptoms (hypertensive emergency) despite similarly high blood pressure (BP). Individualized assessment of patients presenting with high BP with emphasis on the evaluation of end-organ damage rather than on the specific BP number is a key in guiding physician's initial management of a hypertensive crisis. The main aim of the treatment of hypertensive crisis is the prevention or treatment of life-threatening complications of hypertension-induced organ dysfunction, including neurologic, ophthalmologic, renal, and cardiac complications. While the treatment strategy must be directed toward the immediate reduction of BP to reduce the hypertensive damage to these organs, it should not be at a too fast rate to cause hypoperfusion of vital organs by an excessively rapid reduction of BP. Thus, intravenous continuous infusions rather than intravenous boluses of antihypertensive medications should be the preferable mode of initial treatment of children with hypertensive emergency.
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Affiliation(s)
- Tomáš Seeman
- Department of Pediatrics and Biomedical Center, 2nd Faculty of Medicine and Faculty of Medicine in Pilsen, Charles University in Prague, V Uvalu 84, 15006, Prague 5, Czech Republic. .,Motol University Hospital, V Uvalu 84, 15006, Prague 5, Czech Republic.
| | - Gilad Hamdani
- Division of Nephrology and Hypertension, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Mark Mitsnefes
- Division of Nephrology and Hypertension, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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9
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Magray MA, Mufti GN, Bhat NA, Baba AA, Buch MH, Hasan FU, Banday SB. Posterior Reversible Encephalopathy Syndrome after Augmentation Cystoplasty in a Child with Neurogenic Bladder. J Indian Assoc Pediatr Surg 2018; 23:158-160. [PMID: 30050267 PMCID: PMC6042172 DOI: 10.4103/jiaps.jiaps_204_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Posterior reversible encephalopathy syndrome (PRES) or leukoencephalopathy syndrome was introduced into clinical practice in 1996 by Hinchey et al., to describe unique syndrome, clinically expressed during hypertensive and uremic encephalopathy, eclampsia, and immunosuppressive therapy. Hyperperfusion with resultant disruption of the blood–brain barrier results in vasogenic edema, but not infarction, most commonly in the parieto-occipital regions. The severity of this clinical symptom varies. For example, the visual disturbance can manifest as blurred vision, homonymous hemianopsia, or even cortical blindness. Patients may be mildly confused or agitated but can become comatose. Other symptoms less commonly seen include nausea, vomiting, seizures, and brainstem deficits. Chronic kidney disease (CKD) and acute kidney injury are both commonly present in patients with PRES. We are presenting a rare case of neurogenic bladder who developed PRES after augmentation cystoplasty due to underlying CKD.
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Affiliation(s)
| | - Gowhar Nazir Mufti
- Department of Pediatric Surgery, SKIMS, Srinagar, Jammu and Kashmir, India
| | - Nisar Ahmad Bhat
- Department of Pediatric Surgery, SKIMS, Srinagar, Jammu and Kashmir, India
| | - Aejaz Ahsan Baba
- Department of Pediatric Surgery, SKIMS, Srinagar, Jammu and Kashmir, India
| | - Mudasir Hamid Buch
- Department of Pediatric Surgery, SKIMS, Srinagar, Jammu and Kashmir, India
| | - Faheem Ul Hasan
- Department of Pediatric Surgery, SKIMS, Srinagar, Jammu and Kashmir, India
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10
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Stârcea M, Gavrilovici C, Munteanu M, Miron I. Focal segmental glomerulosclerosis in children complicated by posterior reversible encephalopathy syndrome. J Int Med Res 2018; 46:1172-1177. [PMID: 29310486 PMCID: PMC5972267 DOI: 10.1177/0300060517746559] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
An uncommon side effect of cyclosporine A (CsA) use is posterior reversible encephalopathy syndrome (PRES). PRES usually develops because of disturbed capacity of posterior cerebral blood flow to autoregulate an acute rise in blood pressure. We present the case of a 10-year-old girl who was previously diagnosed in our department with focal segmental glomerulosclerosis. She was treated with CsA and developed seizures, progressive loss of consciousness, and visual disturbance on the 7th day of treatment. Brain magnetic resonance imaging showed degeneration of white matter with diffuse demyelination in the parietal and posterior occipital lobes, consistent with the diagnosis of PRES. Cases of PRES reported in children are usually secondary to immunosuppressive therapy in oncological and haematological diseases. Our case is the fifth reported case of focal segmental glomerulosclerosis in children treated with CsA and complicated by PRES. Rapid recognition of PRES and stopping neurotoxic therapy early are essential for a good prognosis.
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Affiliation(s)
- Magdalena Stârcea
- Department of Pediatrics, St. Maria Children's Hospital, University of Medicine and Pharmacy "Grigore T. Popa" Iasi, România
| | - Cristina Gavrilovici
- Department of Pediatrics, St. Maria Children's Hospital, University of Medicine and Pharmacy "Grigore T. Popa" Iasi, România
| | - Mihaela Munteanu
- Department of Pediatrics, St. Maria Children's Hospital, University of Medicine and Pharmacy "Grigore T. Popa" Iasi, România
| | - Ingrith Miron
- Department of Pediatrics, St. Maria Children's Hospital, University of Medicine and Pharmacy "Grigore T. Popa" Iasi, România
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Khan SJ, Arshad AA, Fayyaz MB, Ud Din Mirza I. Posterior Reversible Encephalopathy Syndrome in Pediatric Cancer: Clinical and Radiologic Findings. J Glob Oncol 2017; 4:1-8. [PMID: 30241146 PMCID: PMC6181184 DOI: 10.1200/jgo.17.00089] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Purpose Posterior reversible encephalopathy syndrome (PRES) is associated with a
range of medical conditions and medications. In this retrospective analysis,
we present 19 pediatric patients with PRES who had undergone
chemotherapy. Methods We identified four female and 15 male patients diagnosed with PRES on the
basis of clinical and radiologic features. Patient charts were reviewed from
January 2013 to June 2016 after authorization from the institutional review
board. Results The average age of patients with PRES was 7 years. Primary diagnoses were
non-Hodgkin lymphoma (n = 9), acute pre–B-cell leukemia (n = 5),
relapsed pre–B-cell leukemia (n = 2), Hodgkin lymphoma (n = 2), and
Ewing sarcoma (n = 1). PRES occurred during induction chemotherapy in 12
patients. Sixteen patients had hypertension when they developed PRES. Most
of these patients (n = 13) were receiving corticosteroids on diagnosis of
PRES. Common clinical features were hypertension, seizures, and altered
mental status. With the exclusion of three patients, all others required
antiepileptic therapy. Ten of these patients underwent additional magnetic
resonance imaging. Ten patients are still alive. Conclusion In patients who presented to our center with signs and symptoms of
hypertension, seizures, visual loss, or altered mental status, PRES was
mostly seen in those who were undergoing systemic and intrathecal
chemotherapy. Approximately 40% of the patients had reversal of clinical and
radiologic findings. Antiepileptic medications were discontinued after being
seizure free for approximately 6 months.
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Affiliation(s)
- Saadiya Javed Khan
- All authors: Shaukat Khanum Cancer Hospital and Research Center, Lahore, Pakistan
| | - Arjumand Ali Arshad
- All authors: Shaukat Khanum Cancer Hospital and Research Center, Lahore, Pakistan
| | | | - Islah Ud Din Mirza
- All authors: Shaukat Khanum Cancer Hospital and Research Center, Lahore, Pakistan
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12
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Ganesh K, Nair RR, Kurian G, Mathew A, Sreedharan S, Paul Z. Posterior Reversible Encephalopathy Syndrome in Kidney Disease. Kidney Int Rep 2017; 3:502-507. [PMID: 29725657 PMCID: PMC5932131 DOI: 10.1016/j.ekir.2017.10.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Affiliation(s)
- Kartik Ganesh
- Department of Nephrology, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | - Rajesh R Nair
- Department of Nephrology, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | - George Kurian
- Department of Nephrology, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | - Anil Mathew
- Department of Nephrology, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | - Sandeep Sreedharan
- Department of Nephrology, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | - Zachariah Paul
- Department of Nephrology, Amrita Institute of Medical Sciences, Kochi, Kerala, India
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13
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Posterior reversible encephalopathy syndrome in children with kidney disease. Int Urol Nephrol 2017; 49:1793-1800. [DOI: 10.1007/s11255-017-1684-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2017] [Accepted: 08/17/2017] [Indexed: 01/13/2023]
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14
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Malerbi FK, Teixeira SH, Hirai LGG, Matsudo NH, Carneiro ABM. Retinal changes in solid organ and bone marrow transplantation patients. EINSTEIN-SAO PAULO 2017; 15:123-129. [PMID: 28767907 PMCID: PMC5609605 DOI: 10.1590/s1679-45082017ao3992] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Accepted: 05/04/2017] [Indexed: 12/01/2022] Open
Abstract
Objective To evaluate retinal changes in patients who underwent solid organ or bone marrow transplantation. Methods A retrospective analysis of medical records of patients evaluated from February 2009 to December 2016. All patients included underwent funduscopy. Clinical and demographic data regarding transplantation and ophthalmological changes were collected. Results A total of 126 patients were analyzed; of these, 108 underwent transplantation and 18 were in the waiting list. Transplantation modalities were heart, lung, kidney, liver, pancreas, combined pancreas and kidney and bone marrow transplantation. The main pre-transplantation comorbidities were diabetes and arterial hypertension. Of the 108 transplanted patients, 82 (76%) had retinal changes. All patients who underwent pancreas or combined pancreas and kidney transplantation had diabetic retinopathy. The main retinal changes found were diabetic retinopathy, hypertensive retinopathy, retinal vascular occlusions, chorioretinal infections and central serous chorioretinopathy. Conclusion Retinal changes were either related to preexisting conditions, mainly diabetic retinopathy, or developed postoperatively as a complication of the surgical procedure, or as an infection related to the immunosuppressive status, or due to drug toxicity. These patients may present with complex ophthalmological changes and should be carefully evaluated prior to surgery and further followed by an ophthalmologist skilled in the management of diabetic retinopathy and posterior pole infections.
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15
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Aggarwal R, Saxena A, Soni K. Posterior Reversible Encephalopathy Syndrome during Recovery from Hypovolemic Acute Kidney Injury after Trauma; Case Report and Literature Review. Bull Emerg Trauma 2017; 5:215-218. [PMID: 28795068 PMCID: PMC5547211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Revised: 05/08/2017] [Accepted: 05/17/2017] [Indexed: 06/07/2023] Open
Affiliation(s)
- Richa Aggarwal
- Critical and Intensive Care Medicine, Jpn Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India
| | | | - Kapil Soni
- Critical and Intensive Care Medicine, Jpn Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India
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16
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Kontzialis M, Soares BP, Huisman TA. Lesions in the Splenium of the Corpus Callosum on MRI in Children: A Review. J Neuroimaging 2017; 27:549-561. [DOI: 10.1111/jon.12455] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Revised: 05/31/2017] [Accepted: 06/02/2017] [Indexed: 12/11/2022] Open
Affiliation(s)
- Marinos Kontzialis
- Section of Neuroradiology, Department of Radiology; Rush University Medical Center; Chicago IL
| | - Bruno P. Soares
- Pediatric Radiology, Russell H Morgan Department of Radiology and Radiological Science; The Johns Hopkins University School of Medicine; Baltimore MD
| | - Thierry A.G.M. Huisman
- Pediatric Radiology, Russell H Morgan Department of Radiology and Radiological Science; The Johns Hopkins University School of Medicine; Baltimore MD
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17
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Nasri A, Bedoui I, Mrissa R, Riahi A, Derbali H, Zaouali J, Messelmani M, Mansour M. Recurrent status epilepticus in posterior reversible encephalopathy syndrome as initial feature of pediatric lupus: A newly diagnosed case and literature review. Brain Dev 2016; 38:835-41. [PMID: 27068876 DOI: 10.1016/j.braindev.2016.03.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 03/25/2016] [Accepted: 03/28/2016] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Posterior reversible encephalopathy syndrome (PRES) is a recently described clinico-neuroradiological syndrome with several predisposing conditions. Systemic lupus erythematosus (SLE), beginning in 15-20% in childhood, is considered as a potential underlying etiology of PRES. In children, status epilepticus (SE) rarely complicates PRES, and exceptionally occurs in SLE. METHODS We report on an illustrative case of PRES complicating pediatric lupus revealed by recurrent SE, and we further review through a Pubmed search the previously reported cases of pediatric SLE, PRES and SE. RESULTS We describe the case of a 12-year old girl who presented with recurrent status epilepticus associated to high blood pressure and renal involvement. Brain imaging showed classical aspects of PRES. Immunological tests including antinuclear, anti-DNA, and anticardiolipin antibodies were positive. The diagnosis of SLE was established. The Pubmed search identified a total number of 9 children with SE in SLE, and 26 with PRES, including our patient. CONCLUSIONS We discussed the clinical and paraclinical features of PRES in SLE with epilepsy, their underlying pathophysiological aspects, and their management challenges. PRES should be considered in initial recurrent SE in children, justifying a battery of tests comprising immunological testing. Anticardiolipin antibodies seem to play a crucial role in epilepsy, PRES and renal involvement in pediatric SLE. Further studies are needed to clarify whether PRES should be considered one of the neuropsychiatric manifestations of SLE or a consequence of active disease in other organ systems or its treatment.
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Affiliation(s)
- Amina Nasri
- Department of Neurology, Military Hospital, Tunisia.
| | - Ines Bedoui
- Department of Neurology, Military Hospital, Tunisia
| | - Ridha Mrissa
- Department of Neurology, Military Hospital, Tunisia
| | - Anis Riahi
- Department of Neurology, Military Hospital, Tunisia
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Gupta V, Bhatia V, Khandelwal N, Singh P, Singhi P. Imaging Findings in Pediatric Posterior Reversible Encephalopathy Syndrome (PRES): 5 Years of Experience From a Tertiary Care Center in India. J Child Neurol 2016; 31:1166-73. [PMID: 27071468 DOI: 10.1177/0883073816643409] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Accepted: 03/14/2016] [Indexed: 11/16/2022]
Abstract
This study sought to evaluate the radiological and clinical spectrum of posterior reversible encephalopathy syndrome (PRES) in pediatric population. A retrospective evaluation of the pediatric patients with posterior reversible encephalopathy syndrome seen over the last 5 years in the authors' hospital was done. The magnetic resonance imaging (MRI) findings were analyzed, and a review of literature was performed. Out of 32 pediatric patients of posterior reversible encephalopathy syndrome, 10 (31.25%) were males and 22 (68.75%) were females, with a mean age of 10.6 years. Renal disease (62.5%) was the most common primary disease, followed by chemotherapy for hemato-oncologic malignancies (15.6%). Hypertension was present in 81.2% of cases. Atypical MRI findings were seen in 62.5% cases. Frontal involvement was common and seen in 56% of the cases. Overall, MRI findings considered atypical in adults were found to be common in the series of pediatric posterior reversible encephalopathy syndrome. The understanding of the clinical settings and familiarity with radiological findings in pediatric posterior reversible encephalopathy syndrome patients is important to adequately treat these patients and to avoid misdiagnosis.
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Affiliation(s)
- Vivek Gupta
- Department of Radiodiagnosis, PGIMER, Chandigarh, India
| | - Vikas Bhatia
- Department of Radiodiagnosis, PGIMER, Chandigarh, India
| | | | | | - Pratibha Singhi
- Department of Pediatric Neurology, PGIMER, Chandigarh, India
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Abstract
Post-infectious hemolytic uremic syndrome (HUS) is caused by specific pathogens in patients with no identifiable HUS-associated genetic mutation or autoantibody. The majority of episodes is due to infections by Shiga toxin (Stx) producing Escherichia coli (STEC). This chapter reviews the epidemiology and pathogenesis of STEC-HUS, including bacterial-derived factors and host responses. STEC disease is characterized by hematological (microangiopathic hemolytic anemia), renal (acute kidney injury) and extrarenal organ involvement. Clinicians should always strive for an etiological diagnosis through the microbiological or molecular identification of Stx-producing bacteria and Stx or, if negative, serological assays. Treatment of STEC-HUS is supportive; more investigations are needed to evaluate the efficacy of putative preventive and therapeutic measures, such as non-phage-inducing antibiotics, volume expansion and anti-complement agents. The outcome of STEC-HUS is generally favorable, but chronic kidney disease, permanent extrarenal, mainly cerebral complication and death (in less than 5 %) occur and long-term follow-up is recommended. The remainder of this chapter highlights rarer forms of (post-infectious) HUS due to S. dysenteriae, S. pneumoniae, influenza A and HIV and discusses potential interactions between these pathogens and the complement system.
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Affiliation(s)
- Denis F. Geary
- Division of Nephrology, The Hospital for Sick Children, Toronto, Ontario Canada
| | - Franz Schaefer
- Division of Pediatric Nephrology, University of Heidelberg, Heidelberg, Germany
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20
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Chen LW, Chen JS, Tu YF, Wang ST, Wang LW, Tsai YS, Huang CC. Age-dependent vulnerability of cyclosporine-associated encephalopathy in children. Eur J Paediatr Neurol 2015; 19:464-71. [PMID: 25769225 DOI: 10.1016/j.ejpn.2015.02.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2014] [Revised: 02/06/2015] [Accepted: 02/20/2015] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Cyclosporine (CsA) is an immunosuppressant known for its neurotoxicity, which presents with acute encephalopathy and seizures in the most severe form. However, whether there is age-related neurological susceptibility in pediatric population is poorly defined. The study aims to examine the vulnerability of CsA neurotoxicity among different age groups of pediatric patients in terms of occurrence rate, acute presentations, long-term outcomes, and neuroimaging findings. METHODS Pediatric patients (age <18 years) who received CsA in a tertiary referral center between July 1, 1988 and August 31, 2011 were retrospectively reviewed for CsA-related encephalopathy. The clinical presentations, demographic data, and laboratory examinations were analyzed through t-test for numerical and Fisher's exact test for categorical variables. Exact logistic regression was used to examine the effect of each variables. RESULTS Twelve (8%) of the enrolled 146 patients developed CsA-induced encephalopathy. Compared to the non-neurotoxicity group, the neurotoxicity group was significantly younger upon starting CsA (p = 0.008) and had higher percentages of hypertension after CsA treatment (p = 0.01). Regression analysis showed that age <6 years (OR 7.6, 95% CI 1.6-51.5; p = 0.007) and hypertension after CsA (OR 6.3, 95% CI 1.4-35.4; p = 0.016) were significantly associated with CsA encephalopathy. Younger children were prone to have more severe seizures in the acute stage and more epilepsy and neuropsychiatric disorders in the future. Follow-up neuroimaging showed parietal cerebral atrophy in all examined children <6 years of age. CONCLUSIONS Age-dependent susceptibility of CsA neurotoxicity occurs in children, with severe acute presentations and long-term sequelae in children below 6 years old.
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Affiliation(s)
- Li-Wen Chen
- Department of Pediatrics, National Cheng Kung University Hospital and College of Medicine, Tainan, Taiwan
| | - Jiann-Shiuh Chen
- Department of Pediatrics, National Cheng Kung University Hospital and College of Medicine, Tainan, Taiwan
| | - Yi-Fang Tu
- Department of Pediatrics, National Cheng Kung University Hospital and College of Medicine, Tainan, Taiwan
| | - Shan-Tair Wang
- Institute of Gerontology, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Lan-Wan Wang
- Department of Pediatrics, Chi Mei Medical Center, Tainan, Taiwan; Department of Pediatrics, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Yi-Shan Tsai
- Department of Diagnostic Radiology, National Cheng Kung University Hospital and College of Medicine, Tainan, Taiwan
| | - Chao-Ching Huang
- Department of Pediatrics, National Cheng Kung University Hospital and College of Medicine, Tainan, Taiwan; Department of Pediatrics, College of Medicine, Taipei Medical University, Taipei, Taiwan; Department of Pediatrics, Wan-Fang Hospital, Taipei Medical University, Taipei, Taiwan.
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Bhat RA, Wani Z, Baasit S, Khan I. Clinical course, laboratory parameters and outcome of TTP pediatric patients presenting with posterior reversible encephalopathy syndrome. Ren Fail 2015; 37:974-9. [PMID: 25974726 DOI: 10.3109/0886022x.2015.1044400] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
AIM The clinical course and outcome of children with thrombotic thrombocytopenic purpura and posterior reversible encephalopathy has not been observed and studied till date. The aim of the present study was to know the clinical course and outcome of children with thrombotic thrombocytopenic purpura and posterior reversible encephalopathy. Results from our observation invite potential insight for further research on this subject. METHODS From January 2005 to February 2013, seven children diagnosed with thrombotic thrombocytopenic purpura and posterior reversible encephalopathy syndromes were admitted in a tertiary care hospital in Srinagar, Kashmir. The demographic parameters, clinical characteristics and laboratory data were noted. The outcome was defined in the form of complete recovery or death. Thrombotic thrombocytopenic purpura was diagnosed on clinical grounds, laboratory parameters and renal biopsy. The diagnosis was established after an expert opinion from a hematologist. Posterior reversible encephalopathy syndrome was defined on neuroimaging. RESULTS The common clinical parameters which were shared by all the patients were hypertension and altered sensorium. Four (57.1%) patients showed clinical deterioration and died within one week of admission even after intensive management. Three (42.8%) patients improved clinically and recovered fully and were discharged in stable clinical condition. Repeat imaging on discharge was normal. CONCLUSION This series of seven pediatric patients is the first series on this subject. The presence of posterior reversible encephalopathy syndrome in pediatric patients with thrombotic thrombocytopenic purpura complicates the clinical course and worsens the prognosis.
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Affiliation(s)
- Riyaz Ahmad Bhat
- a Department of Internal Medicine , Sher-i-Kashmir Institute of Medical Sciences , Srinagar , Kashmir , India
| | - Zeeshan Wani
- b Department of Gastroenterology , Institute of Liver and Billiary Sciences , New Delhi , India
| | - Syed Baasit
- c Department of Orthopedics , Bones and Joint Hospital , Srinagar , Kashmir , India , and
| | - Imran Khan
- d Department of Internal Medicine , Sher-i-Kashmir Institute of Medical Sciences , Srinagar , Kashmir , India
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Taylan C, Nitsch-Felsecker P. Plötzliche Amaurose im Rahmen eines akuten nephritischen Syndroms. Monatsschr Kinderheilkd 2014. [DOI: 10.1007/s00112-014-3160-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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