Posterior reversible encephalopathy syndrome and acute post-streptococcal glomerulonephritis mimicking breakthrough seizures

Abstract

We report the case of a 14-year-old boy with a past history of primary generalized seizures, who had been seizure-free for 2 years on sodium valproate and presented with generalized tonic clonic seizures suggestive of breakthrough seizures. Examination revealed hypertension, impetiginous lesions of the lower limbs, microscopic hematuria, elevated anti-streptolysin O titre and low complement levels consistent with acute post-streptococcal glomerulonephritis. Cranial magnetic resonance imaging (MRI) demonstrated changes consistent with posterior reversible encephalopathy syndrome. Hypertension was controlled with intravenous nitroglycerin followed by oral captopril and amlodipine. Brain MRI changes returned normal within 2 weeks. The nephritis went in to remission within 2 months and after 8 months the patient has been seizure free again. Posterior reversible encephalopathy syndrome appeared to have neither short nor intermediate effect on seizure control in this patient. The relationship between posterior reversible encephalopathy syndrome and seizures is reviewed.

Posterior Reversible Encephalopathy Syndrome (Pres) Presenting with Status Epilepticus in the Context of Post-Streptococcal Glomerulonephritis

“…Although it has mainly been described in the adult population, increasing experience regarding the paediatric population is evolving. Several studies have described children with PRES in the setting of acute renal failure, chronic nephritis, vasculitis, malignancy, nephrotic syndrome and a history of use of medication [6][7][8]. However, the syndrome is extremely rare in previously healthy children with not known renal disease and, to our knowledge; just a few cases of PRES have been described in children secondary to streptococcal glomerulonephritis.…”