Posterior reversible leukoencephalopathy syndrome in 17 year old girl

Abstract

Objective - To describe a rare condition in children called posterior reversible leukoencephalopathy syndrome, its causes, diagnostic approach and treatment.

Case report - A 17 year old girl experienced generalized seizures and head trauma after collapsing in the toilet. It was the first seizure in her life. Five days earlier she had given birth. Two more seizures followed in the next few hours after the first. Blood pressure measured at the time of the seizures was normal, but high afterwards. At that point she was admitted to the intensive care unit. Initially, a computed tomography scan was preformed and it revealed a pathologic finding. A magnetic resonance imaging (MRI) scan was performed to confirm the suspected diagnosis of posterior reversible leukoencephalopathy syndrome (PRES). During her stay in hospital other conditions were excluded and hypertension was considered as the cause of PRES. ACE inhibitors corrected the blood pressure. 12 days later her blood pressure and neurological status normalized, as well as the control MRI finding.

Conclusion - Early recognition and intensive care are essential for a completely reversible outcome in children with PRES. In patients with hypertension, cytotoxic agent treatment or corticosteroid treatment, in case of the first seizure in their life, PRES should be suspected. Atypical MRI features can be expected in children, because the anterior watershed region may be as vulnerable as the vertebro-basilar system. In cases of hypertension, the most important issue is hypertension correction; hypertension should therefore be considered and corrected in treating seizures complicated by PRES.