[Posterior reversible encephalopathy in infancy].
BACKGROUND
Posterior reversible encephalopathy (PRE) is a radiological clinical syndrome that was initially reported in adults and which is characterised by seizures, headache, visual disorders, decreased awareness and anomalous neuroimages. It is an acute transient disorder. The most frequent causes are arterial hypertension (AHT) and immunosuppressive therapy.


OBJECTIVE
The aim of this study is to describe the characteristics of PRE in patients of paediatric age.


METHODS
From a total of 109,267 patients admitted to hospital between 1/1/1999 and 1/8/2002, we reviewed the case histories of seven patients who satisfied PRE criteria.


RESULTS
Seven patients presented AHT associated with kidney disease (6) and with an undetermined causation (1). The initial symptoms were vomiting in seven and headaches in five patients, followed by seizures in six cases, which were partial (4), generalised (1), motor status (1). Five of them suffered visual disorders. All of them had decreased awareness and one of them required the assistance of mechanical ventilation. The condition cleared within 3 to 12 days after antihypertensive therapy. The anomalies that showed up in the neuroimaging studies (hypodensities in CAT, hyperintensities in T2 and hypointensities in T1 in MR) revealed the involvement of cortical and parieto occipital cortico subcortical regions asymmetrically. Frontal (2), temporal (2) and cerebellous (1) involvement was also observed. These disorders disappeared in patients from whom control images were obtained.


CONCLUSIONS
PRE must be considered in the presence of the symptoms and the anomalous neuroimages described above, when associated with acute AHT. With correct management of arterial hypertension it is possible to clear the neurological symptoms and normalise the neuroimages that confirm this diagnosis.
Arroyo
H A
HA
Servicio de Neurología, Hospital de Pediatria SAMIC, Prof Dr JP Garrahan, Buenos Aires, Argentina. hugoarroyo@arnet.com.ar
Gañez
L A
LA
Fejerman
N
N
D000293:Adolescent; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001927:Brain Diseases / Q000175:diagnosis / Q000188:drug therapy / Q000473:pathology*; D002648:Child; D002675:Child, Preschool; D003952:Diagnostic Imaging; D005260:Female; D006801:Humans; D006973:Hypertension / Q000503:physiopathology; D007223:Infant; D008297:Male; D012189:Retrospective Studies
D000959:Antihypertensive Agents