Abstract
References
- Hinchey, J., C. Chaves, B. Appignani, J. Breen, L. Pao, A. Wang, M.S. Pessin, C. Lamy, J.-L. Mas, and L.R. Caplan, A reversible posterior leukoencephalopathy syndrome. New England Journal of Medicine, 1996. 334(8): p. 494-500.
- McKinney, A.M., J. Short, C.L. Truwit, Z.J. McKinney, O.S. Kozak, K.S. SantaCruz, and M. Teksam, Posterior reversible encephalopathy syndrome: incidence of atypical regions of involvement and imaging findings. American Journal of Roentgenology, 2007. 189(4): p. 904-912.
- Bartynski, W. and J. Boardman, Distinct imaging patterns and lesion distribution in posterior reversible encephalopathy syndrome. American Journal of Neuroradiology, 2007. 28(7): p. 1320-1327.
- Tetsuka, S. and T. Ogawa, Posterior reversible encephalopathy syndrome: a review with emphasis on neuroimaging characteristics. Journal of the neurological sciences, 2019. 404: p. 72-79.
- Schwartz, R., K. Jones, P. Kalina, R. Bajakian, M. Mantello, B. Garada, and B. Holman, Hypertensive encephalopathy: findings on CT, MR imaging, and SPECT imaging in 14 cases. AJR. American journal of roentgenology, 1992. 159(2): p. 379-383.
- Lee, V.H., E.F. Wijdicks, E.M. Manno, and A.A. Rabinstein, Clinical spectrum of reversible posterior leukoencephalopathy syndrome. Archives of neurology, 2008. 65(2): p. 205-210.
- Burnett, M.M., C.P. Hess, J.P. Roberts, N.M. Bass, V.C. Douglas, and S.A. Josephson, Presentation of reversible posterior leukoencephalopathy syndrome in patients on calcineurin inhibitors. Clinical neurology and neurosurgery, 2010. 112(10): p. 886-891.
- Cordelli, D.M., R. Masetti, E. Ricci, F. Toni, D. Zama, M. Maffei, A. Gentili, A. Parmeggiani, A. Pession, and E. Franzoni, Life-threatening complications of posterior reversible encephalopathy syndrome in children. European Journal of Paediatric Neurology, 2014. 18(5): p. 632-640.
- Masetti, R., D.M. Cordelli, D. Zama, F. Vendemini, C. Biagi, E. Franzoni, and A. Pession, PRES in children undergoing hematopoietic stem cell or solid organ transplantation. Pediatrics, 2015. 135(5): p. 890-901.
- Sharma, A., R.T. Whitesell, and K.J. Moran, Imaging pattern of intracranial hemorrhage in the setting of posterior reversible encephalopathy syndrome. Neuroradiology, 2010. 52: p. 855-863.
- Liu, W., X. Zhu, and Y. Xiao, Neurological involvement in hematopoietic stem cell transplantation-associated thrombotic microangiopathy. Annals of Hematology, 2024: p. 1-11.
- Fugate, J.E., D.O. Claassen, H.J. Cloft, D.F. Kallmes, O.S. Kozak, and A.A. Rabinstein. Posterior reversible encephalopathy syndrome: associated clinical and radiologic findings. in Mayo Clinic Proceedings. 2010. Elsevier.
- Strother, R., H. Wong, and N.E. Miller, Posterior Reversible Encephalopathy Syndrome Secondary to Hypertensive Encephalopathy Brought on by a MAO Inhibitor: A Case Report. Journal of primary care & community health, 2019. 10: p. 2150132719869539.
- Gijtenbeek, J., M. Van den Bent, and C.J. Vecht, Cyclosporine neurotoxicity: a review. Journal of neurology, 1999. 246(5): p. 339-346.
Abstract
Aim: This study evaluates the clinical and radiological characteristics, treatment approaches, and outcomes of pediatric patients diagnosed with Posterior Reversible Encephalopathy Syndrome (PRES) in a pediatric intensive care unit and hematology service.
Materials and Methods: A retrospective analysis was conducted on 32 pediatric patients diagnosed with PRES between 2015 and 2023. Patients were followed up for at least two years. Demographic data, clinical features, and radiological findings were collected. EEGs were performed during the acute period and in follow-ups longer than three months. MRIs were evaluated by a multidisciplinary team. Vital signs were closely monitored, and blood pressure and intracranial pressure were managed.
Results: Of the 32 patients, 9 were female (28%) and 23 were male (72%), aged between 26-214 months. The majority had undergone bone marrow transplantation (BMT), with 81% developing PRES post-transplant. Seizures were the most common symptom, occurring in 94% of cases. Antiepileptic drugs (AEDs) such as levetiracetam and clonazepam were used for seizure management. MRIs showed T2-weighted hyperintense lesions in all patients. The primary underlying conditions included acute lymphoblastic leukemia (ALL), chronic renal failure (CRF), and thalassemia major. Hypertension was present in all patients.
Conclusion: The study highlights the high incidence of PRES in pediatric patients undergoing allogeneic hematopoietic stem cell transplantation (HSCT) and underscores the importance of early recognition and management of modifiable risk factors, particularly hypertension. Appropriate and timely intervention can significantly improve long-term outcomes for affected individuals. Further research is necessary to explore the pathophysiological mechanisms and optimize treatment strategies for PRES in pediatric populations.
References
- Hinchey, J., C. Chaves, B. Appignani, J. Breen, L. Pao, A. Wang, M.S. Pessin, C. Lamy, J.-L. Mas, and L.R. Caplan, A reversible posterior leukoencephalopathy syndrome. New England Journal of Medicine, 1996. 334(8): p. 494-500.
- McKinney, A.M., J. Short, C.L. Truwit, Z.J. McKinney, O.S. Kozak, K.S. SantaCruz, and M. Teksam, Posterior reversible encephalopathy syndrome: incidence of atypical regions of involvement and imaging findings. American Journal of Roentgenology, 2007. 189(4): p. 904-912.
- Bartynski, W. and J. Boardman, Distinct imaging patterns and lesion distribution in posterior reversible encephalopathy syndrome. American Journal of Neuroradiology, 2007. 28(7): p. 1320-1327.
- Tetsuka, S. and T. Ogawa, Posterior reversible encephalopathy syndrome: a review with emphasis on neuroimaging characteristics. Journal of the neurological sciences, 2019. 404: p. 72-79.
- Schwartz, R., K. Jones, P. Kalina, R. Bajakian, M. Mantello, B. Garada, and B. Holman, Hypertensive encephalopathy: findings on CT, MR imaging, and SPECT imaging in 14 cases. AJR. American journal of roentgenology, 1992. 159(2): p. 379-383.
- Lee, V.H., E.F. Wijdicks, E.M. Manno, and A.A. Rabinstein, Clinical spectrum of reversible posterior leukoencephalopathy syndrome. Archives of neurology, 2008. 65(2): p. 205-210.
- Burnett, M.M., C.P. Hess, J.P. Roberts, N.M. Bass, V.C. Douglas, and S.A. Josephson, Presentation of reversible posterior leukoencephalopathy syndrome in patients on calcineurin inhibitors. Clinical neurology and neurosurgery, 2010. 112(10): p. 886-891.
- Cordelli, D.M., R. Masetti, E. Ricci, F. Toni, D. Zama, M. Maffei, A. Gentili, A. Parmeggiani, A. Pession, and E. Franzoni, Life-threatening complications of posterior reversible encephalopathy syndrome in children. European Journal of Paediatric Neurology, 2014. 18(5): p. 632-640.
- Masetti, R., D.M. Cordelli, D. Zama, F. Vendemini, C. Biagi, E. Franzoni, and A. Pession, PRES in children undergoing hematopoietic stem cell or solid organ transplantation. Pediatrics, 2015. 135(5): p. 890-901.
- Sharma, A., R.T. Whitesell, and K.J. Moran, Imaging pattern of intracranial hemorrhage in the setting of posterior reversible encephalopathy syndrome. Neuroradiology, 2010. 52: p. 855-863.
- Liu, W., X. Zhu, and Y. Xiao, Neurological involvement in hematopoietic stem cell transplantation-associated thrombotic microangiopathy. Annals of Hematology, 2024: p. 1-11.
- Fugate, J.E., D.O. Claassen, H.J. Cloft, D.F. Kallmes, O.S. Kozak, and A.A. Rabinstein. Posterior reversible encephalopathy syndrome: associated clinical and radiologic findings. in Mayo Clinic Proceedings. 2010. Elsevier.
- Strother, R., H. Wong, and N.E. Miller, Posterior Reversible Encephalopathy Syndrome Secondary to Hypertensive Encephalopathy Brought on by a MAO Inhibitor: A Case Report. Journal of primary care & community health, 2019. 10: p. 2150132719869539.
- Gijtenbeek, J., M. Van den Bent, and C.J. Vecht, Cyclosporine neurotoxicity: a review. Journal of neurology, 1999. 246(5): p. 339-346.
Details
| Primary Language | English |
|---|---|
| Subjects | Pediatric Neurology |
| Journal Section | Research Article |
| Authors | |
| Early Pub Date | April 29, 2025 |
| Publication Date | April 30, 2025 |
| Submission Date | November 30, 2024 |
| Acceptance Date | April 13, 2025 |
| Published in Issue | Year 2025 Volume: 14 Issue: 1 |
