[P1-38] A case of unilateral posterior reversible encephalopathy syndrome in children
[Introduction] Posterior reversible encephalopathy syndrome (PRES) is a neurological condition caused by reversible vasogenic brain edema secondary to hypertension, cytotoxic drugs, renal disease, autoimmune disorders; PRES is characterized by acute neurological symptoms such as seizure, headache, visual disturbance and impaired levels of consciousness and brain imaging usually showing bilateral, vasogenic edema. Completely unilateral PRES is very rare and is accounted for only 2.6% of the PRES cases reported in previous studies. We experienced an unilateral PRES case in a previously healthy boy, and hereby reports the proper diagnosis and early treatment of unilateral PRES.
[Case] A 13 year old boy presented with fever and diarrhea for 4days. On the fourth day of hospitalization, generalized tonic-clonic(GTC) seizure with upward eyeball deviation for 5mins was noted after severe headache. Few hours later, suddenly the patient complained of Rt arm weakness, which was followed by GTC seizure. His blood pressure, pulse were 188/112 mmHg, 122 bpm. Immediately after the second seizure ended, hydralazine was administered and nicardipine infusion was started. T2 FLAIR demonstrated high signal intensity in the cortical gyri of the left frontal, parietal, and occipital lobes.
Further evaluation including Abdominal CT scan, renal angiography showed small left kidney with Lt renal artery stenosis. Adjuvant balloon inflation of the almost total occlusive Lt renal artery was performed.
[Conclusion] Permanent sequelae may ensue if the proper diagnosis and treatment of unilateral PRES are delayed. Therefore, it is important for healthcare professionals to be aware that PRES can occur unilaterally as well as bilaterally.
[Case] A 13 year old boy presented with fever and diarrhea for 4days. On the fourth day of hospitalization, generalized tonic-clonic(GTC) seizure with upward eyeball deviation for 5mins was noted after severe headache. Few hours later, suddenly the patient complained of Rt arm weakness, which was followed by GTC seizure. His blood pressure, pulse were 188/112 mmHg, 122 bpm. Immediately after the second seizure ended, hydralazine was administered and nicardipine infusion was started. T2 FLAIR demonstrated high signal intensity in the cortical gyri of the left frontal, parietal, and occipital lobes.
Further evaluation including Abdominal CT scan, renal angiography showed small left kidney with Lt renal artery stenosis. Adjuvant balloon inflation of the almost total occlusive Lt renal artery was performed.
[Conclusion] Permanent sequelae may ensue if the proper diagnosis and treatment of unilateral PRES are delayed. Therefore, it is important for healthcare professionals to be aware that PRES can occur unilaterally as well as bilaterally.