Qalab abbas, MBBS
Assistant Professor
Aga Khan University
Karachi, Saskatchewan, United States
Disclosure information not submitted.
Title: Posterior Reversible Encephalopathy Syndrome in critically ill children: risk factors and outcomes
Introduction: Posterior reversible encephalopathy syndrome (PRES) is a combination of clinical-radiological features including seizures, altered mentation, and focal deficits, whilst MRI findings include symmetric, edematous posterior brain parenchyma. PRES’s prevalence in high-risk pediatric patients is not well described, and further data is needed on its presentation, risk factors and outcomes.
Methods: A retrospective review medical records of children admitted to the PICU with clinical and radiological features of PRES was done, using a decade-long data pool. We report patient demographics, associated factors, PICU course and duration of stay, along with outcome. Use of anti-hypertensives and anti-epileptic drugs for symptomatic management was also mentioned.
Results: A total of 17 patients were identified; median age was 12 years and 52.9% were females. Commonly seen comorbid were renal disease (n= 6, 35.3%), malignancy (n=3, 17.6%), systemic diseases (n=5, 29.4%), and neurological conditions (n=2, 11.8%). The most frequently encountered precipitating factors for PRES were hypertension (n=11, 64.7%) and use of cytotoxic drugs (n=8, 47.1%). Seizures (n=15, 88.2%) and altered mentation (n=10, 58.8%) were the most prominent symptom among these patients. MRI brain findings in all patients consisted of bilateral, symmetric abnormal signaling in parieto-occipital and temporal lobes. Mean length of stay in the PICU was 5.3 ± 8.24 days. A total of nine patients (52.9%) required invasive mechanical ventilation. Fifteen patients recovered completely and two expired.
Conclusion: PRES should be considered in the differential diagnosis of acute encephalopathy in patients who present with new onset seizures and systemic hypertension. Early recognition and intensive care management is essential to achieve a completely reversible outcome in critically-ill children with this syndrome.