title: Severe posterior reversible encephalopathy syndrome resolved with craniectomy.
abstract: Posterior reversible encephalopathy syndrome (PRES) has been thought to be a benign disease, but recently severe cases have been reported with increasing recognition. A 3-year-old girl with congenital nephrotic syndrome had rapidly progressed to coma. Computed tomography (CT) of the head showed striking swelling of the brainstem and transtentorial herniation. Emergency decompressive craniectomy was performed. Consecutively, blood pressure was optimally controlled. The patient gradually recovered to the previous state before onset of PRES. Rapid improvement of clinical symptoms and rapid resolution of abnormal findings on serial CT led to diagnosis of PRES. In severe PRES with unstable vital signs, surgical intervention should be considered as well as appropriate blood pressure management.
authors.affiliation: Department of Nephrology, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan.
authors.forename: Yoshinobu
authors.initials: Y
authors.lastname: Nagaoka
authors.forename: Kenji
authors.initials: K
authors.lastname: Ishikura
authors.forename: Riku
authors.initials: R
authors.lastname: Hamada
authors.forename: Tadashi
authors.initials: T
authors.lastname: Miyagawa
authors.forename: Tatsuo
authors.initials: T
authors.lastname: Kono
authors.forename: Tomoyuki
authors.initials: T
authors.lastname: Sakai
authors.forename: Yuko
authors.initials: Y
authors.lastname: Hamasaki
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Hataya
authors.forename: Masataka
authors.initials: M
authors.lastname: Honda
mesh_terms: D001933:Brain Stem / Q000000981:diagnostic imaging / Q000473:pathology; D002675:Child, Preschool; D056424:Decompressive Craniectomy / Q000379:methods*; D003937:Diagnosis, Differential; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging; D059906:Neuroimaging / Q000379:methods*; D054038:Posterior Leukoencephalopathy Syndrome / Q000000981:diagnostic imaging / Q000601:surgery*; D014057:Tomography, X-Ray Computed
keywords: brainstem; cerebellar herniation; decompressive craniectomy; reversible posterior leukoencephalopathy syndrome