Clinicoradiological findings and outcome of posterior reversible encephalopathy syndrome in children: a cross-sectional study

Abstract

Background and Objective:

Posterior reversible encephalopathy syndrome (PRES) is a clinicoradiological  syndrome characterised by altered sensorium, seizures, visual impairment and behavioural changes. The objective of the study was to evaluate clinicoradiological findings and outcome of PRES in children.

Methods:

A prospective cross-sectional study was conducted at department of pediatric neurology, the Children’s Hospital Lahore from October 2020 to September 2023. Clinical and demographic data were colllected on a structured proforma. Investigations comprised complete blood count, biochemistry, urinalysis, complement levels, inflammatory markers, immune panel, lipid profile and abdominal ultrasonography. All patients underwent MRI brain. Outcome was categorized as complete recovery or persistence of neurological deficits and/or residual radiological abnormalities at six months. Data were analyzed using SPSS version 23.

Results:

 Thirty patients enrolled with male predominance (53.3%; male-to-female ratio of 1.14:1) and mean age of 10.86 ± 2.22 years. Hypertension was universal followed by seizures (93.3%), headache (83.3%), altered sensorium/aphasia (80%), visual impairment (70%), pyramidal signs (70%), peripheral edema (66.7%) and motor deficits (43.3%).  Renal disorders accounted for 83.3% cases, most commonly post-infectious glomerulonephritis (43.3%). MRI revealed reversible vasogenic edema on T2-weighted/FLAIR sequences, predominantly in occipital (100%) and parietal lobes (90%). 6.7% patients had ischemic changes correlating with visual loss.

Conclusion: PRES in children presents with diverse neurological manifestations associated with hypertension secondary to renal diseases. MRI plays a pivotal diagnostic role. Early recognition with timely management is essential to prevent deficits.