title: Clinical and neuroimaging findings in children with posterior reversible encephalopathy syndrome.
abstract: OBJECTIVE
  To clarify the clinical and radiological spectrum of posterior reversible encephalopathy syndrome (PRES) in children, and to identify the prognostic factors.
  
  
  METHODS
  The records of 40 children with PRES were reviewed. Acute clinical symptoms, MRI including apparent diffusion coefficient (ADC) maps in the acute and follow-up periods and neurological sequelae, including epilepsy, were noted.
  
  
  RESULTS
  Age at onset ranged from 2 to 16 years. Underlying disorders were hematological or neoplastic disorders (n = 20), renal diseases (n = 14) and others (n = 6). In the acute period, 31 patients had seizures, 25 had altered consciousness, 11 had visual disturbances and 10 had headache. Of 29 patients who had ADC maps in the acute period, 13 had reduced diffusivity as shown by ADC within PRES lesions. Of 26 patients with follow-up MRI, 13 had focal gliosis or cortical atrophy. No patients had motor impairment, and four patients had focal epilepsy. No clinical variables were associated with focal gliosis or cortical atrophy on follow-up MRI, but lesional ADC reduction in the acute period was prognostic for focal gliosis or cortical atrophy on follow-up MRI (p = 0.005).
  
  
  CONCLUSIONS
  To the best of our knowledge, this is the largest cohort study to date involving PRES in children. Acute symptoms in pediatric patients are similar to those reported in adults, but altered consciousness was more frequent in children. Lesional ADC reduction in the acute period was common and was a good predictor of later, irreversible MRI lesions.
authors.affiliation: Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan. Electronic address: h-yamamoto@med.nagoya-u.ac.jp.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Yamamoto
authors.affiliation: Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan.
authors.forename: Jun
authors.initials: J
authors.lastname: Natsume
authors.affiliation: Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Kidokoro
authors.affiliation: Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan.
authors.forename: Naoko
authors.initials: N
authors.lastname: Ishihara
authors.affiliation: Department of Neurology, Aichi Children's Health and Medical Center, Obu, Japan.
authors.forename: Motomasa
authors.initials: M
authors.lastname: Suzuki
authors.affiliation: Department of Pediatrics, Okazaki City Hospital, Okazaki, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Tsuji
authors.affiliation: Department of Pediatrics, Anjo Kosei Hospital, Anjo, Japan.
authors.forename: Tetsuo
authors.initials: T
authors.lastname: Kubota
authors.affiliation: Department of Pediatrics, Social Insurance Chukyo Hospital, Nagoya, Japan.
authors.forename: Akio
authors.initials: A
authors.lastname: Yamada
authors.affiliation: Department of Pediatrics, Graduate School of Medicine, Gifu University, Gifu, Japan.
authors.forename: Michio
authors.initials: M
authors.lastname: Ozeki
authors.affiliation: Department of Pediatrics, Graduate School of Medicine, Gifu University, Gifu, Japan.
authors.forename: Zenichiro
authors.initials: Z
authors.lastname: Kato
authors.affiliation: Department of Pediatrics, Fujita Health University School of Medicine, Toyoake, Japan.
authors.forename: Yoshiki
authors.initials: Y
authors.lastname: Kawamura
authors.affiliation: Department of Pediatrics, Fujita Health University School of Medicine, Toyoake, Japan.
authors.forename: Tetsushi
authors.initials: T
authors.lastname: Yoshikawa
authors.affiliation: Department of Pediatrics, Aichi Medical University, Nagakute, Japan; Department of Pediatrics, Juntendo University School of Medicine, Tokyo, Japan.
authors.forename: Akihisa
authors.initials: A
authors.lastname: Okumura
authors.affiliation: Department of Pediatrics and Neonatology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
authors.forename: Naoki
authors.initials: N
authors.lastname: Ando
authors.affiliation: Department of Pediatrics and Neonatology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
authors.forename: Shinji
authors.initials: S
authors.lastname: Saitoh
authors.affiliation: Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan.
authors.forename: Yoshiyuki
authors.initials: Y
authors.lastname: Takahashi
authors.affiliation: Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan.
authors.forename: Kazuyoshi
authors.initials: K
authors.lastname: Watanabe
authors.affiliation: Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan.
authors.forename: Seiji
authors.initials: S
authors.lastname: Kojima
mesh_terms: D000293:Adolescent; D001921:Brain / Q000473:pathology; D002648:Child; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D059906:Neuroimaging; D054038:Posterior Leukoencephalopathy Syndrome / Q000150:complications / Q000473:pathology*
keywords: ADC; Brain edema; Diffusion-weighted MRI; Electroencephalogram; Epilepsy; Hypertension; Pediatrics; Posterior reversible encephalopathy syndrome; Prognosis; Seizures