Challenges of Diagnosing Pediatric Posterior Reversible Encephalopathy Syndrome in Resource Poor Settings: A Narrative Review

Abstract

Posterior reversible encephalopathy syndrome (PRES) is a rare clinical syndrome that has been observed in different age groups, including pediatric patients. Identified triggers of PRES in both children and adults have included immunosuppressive and cytotoxic agents, organ transplantation, severe sepsis, blood transfusion, or evidence of human immunodeficiency virus-1 (HIV-1). Its clinical and radiological courses have been reported as mostly benign and reversible over days to weeks. Computed tomography (CT) scans are helpful in diagnosis, but magnetic resonance imaging (MRI) remains the gold standard. Unfortunately, because of the prohibitive costs of such medical equipment, diagnosis remains a challenge in developing countries. There is a dearth of information about pediatric PRES in resource–poor settings. This narrative aims to draw attention to the possible existence of PRES in children and to identify factors responsible for the difficulty in making the diagnosis. This review will hopefully increase awareness of PRES among pediatricians in order to make early diagnosis and institute appropriate management of this condition.

Pediatric Posterior Reversible Encephalopathy Syndrome: A Review With Emphasis on Neuroimaging Characteristics

“…Atypical MRI lesions are significantly more prevalent in children with PRES than in adults, with reported incidence rates ranging from 61% to 82% in children compared to 10% to 58% in adults [46]. This observation is supported by evidence from several studies.…”

Management of posterior reversible encephalopathy syndrome in a pediatric patient with a rare adrenocortical tumor after computed tomography-guided biopsy

“…The principles of the management of PRES that we followed were also similar to the previous case reports that included intensive care requirements, antihypertensives, antiepileptics, and supportive care [6][7][8][9]. There are no specific protocols for prescribing antiepileptics or antihypertensive drugs in PRES management, but the mainstay of management is the treatment of hypertension and control of seizures with antiepileptic drugs [1][2][3]11]. The patient was planned for evaluation in subsequent visits but did not appear for follow-up and could not be traced back.…”