Etiology and clinical characteristics of pediatric non-neoplastic posterior reversible encephalopathy: systematic review

Abstract

Background: Although more commonly seen in adult population, posterior reversible encephalopathy syndrome (PRES) can also be observed in pediatric patients. The etiopathogenesis of pediatric PRES is poorly understood, and the available evidence comes mostly from childhood cancer. Analysis of the sociodemographic and clinical characteristics of the different noncancer-related types can improve the understanding of pediatric PRES.Methods: Systematic review of characteristics and outcome of noncancer pediatric PRES. Primary sources of investigation were identified and selected through Pubmed and Scopus databases. The research was complemented by reference search in relevant publications. Study protocol was registered (Prospero CRD42020165798).Results: We identified 449 cases of noncancer pediatric PRES from 272 studies, median age 10 (newborn to 17 years), 49.9% girls. The 4 most common groups of conditions were renal 165 (36.7%), hematologic 84 (18.7%), autoimmune 64 (14.3%), and cardiovascular 28 (6.2%) disorders. The 4 most prevalent precipitants identified were hypertensive crisis 119 (26.5%), corticosteroids 56 (12.5%), immunosuppression drugs 44 (9.8%), and biologic drugs 14 (3.1%). Clinical presentations included seizures 100 (22.3%), headaches 22 (4.9%), encephalopathy 17 (3.8%), visual disturbances 6 (1.3%), and focal deficit 3 (0.7%). The distribution of lesions was (n = 380): combined anterior/posterior circulation (40.8%), isolated posterior circulation (24.1%), anterior circulation (6.2%), and deep structures (1.6%). Residual neurological deficits occurred in about 1 out 10 cases.Conclusion: Pediatric PRES differs from the adult in etiology, precipitants, and clinical manifestations. Renal diseases predominate, acute raised blood pressure is less frequent, and cortical deficits are rarer. In addition, the proportion of patients with combined anterior/posterior circulation was higher. Permanent neurological sequels can occur.

Posterior reversible encephalopathy syndrome in a child after burns: A case report and literature review

“…7–9 PRES differs from the adult in aetiology, precipitants, and clinical manifestations. 2 The proportion of patients with combined anterior/posterior circulation was higher. 2…”

“…[7][8][9] PRES differs from the adult in aetiology, precipitants, and clinical manifestations. 2 The proportion of patients with combined anterior/posterior circulation was higher. 2 In 2020, Wake et al 10 reported a case of PRES that developed during the treatment of severe burns in a 13-year-old boy.…”

“…2 The proportion of patients with combined anterior/posterior circulation was higher. 2 In 2020, Wake et al 10 reported a case of PRES that developed during the treatment of severe burns in a 13-year-old boy. The authors believed that it was caused by an increase in blood pressure, blood vessel dilation, angioedema, and stress during skin grafting.…”

“…Thus far, most reports of PRES have been reported in adults; reports of PRES in children are limited to nephropathy, allergic diseases, autoimmune diseases, and the use of immunosuppressive and biologic drugs. 2 Reports of burn-related PRES are very rare in the literature. Therefore, it is a clinical entity that many burn medicine physicians may be unfamiliar with.…”

A case study of posterior reversible encephalopathy syndrome: Not always reversible with detrimental consequences

“…Pathophysiology of PRES-Hypertension Theory. PRES = posterior reversible encephalopathy syndrome chronic kidney disease, hypertension, and cardiomegaly(Jordao et al, 2022). Renal disease is the most common cause in children(Ando et al,…”