title: Constipation, renovascular hypertension, and posterior reversible encephalopathy syndrome (PRES).
abstract: Posterior reversible encephalopathy syndrome (PRES) is a clinico-radiological entity characterized by variable associations of headaches, encephalopathy, seizures, vomiting, visual disturbance, and focal neurological signs. Neuroimaging shows cerebral edema of different patterns, classically involving the parieto-occipital white matter. PRES has been associated with several conditions predominantly hypertension, eclampsia, and immunosuppressive therapy. However, constipation has not been previously described in association with the development of PRES. In this report, we describe an 11-year-old child with history of severe functional constipation who developed PRES, as a consequence of renovascular hypertension from severe fecal impaction. Both hypertension and neurologic dysfunction resolved after resolution of fecal impaction.
  
  
  CONCLUSIONS
  Severe functional constipation is a previously unrecognized cause of severe acute hypertension, resulting in life-threatening neurologic dysfunction. We highlight this unrecognized complication of severe functional constipation with fecal impaction that is potentially preventable if managed appropriately.
authors: Department of Pediatrics, Maimonides Medical Center, 977 48th Street, Brooklyn, NY, 11219, USA. Mprasad@maimonidesmed.org.
authors: Malavika
authors: M
authors: Prasad
authors: Department of Pediatrics, Maimonides Medical Center, 977 48th Street, Brooklyn, NY, 11219, USA. Gwetzler@maimonidesmed.org.
authors: Graciela
authors: G
authors: Wetzler
authors: Department of Pediatrics, Maimonides Medical Center, 977 48th Street, Brooklyn, NY, 11219, USA. juliaholtmann@yahoo.de.
authors: Julia
authors: J
authors: Holtmann
authors: Department of Pediatrics, Maimonides Medical Center, 977 48th Street, Brooklyn, NY, 11219, USA. Hdapul@maimonidesmed.org.
authors: Heda
authors: H
authors: Dapul
authors: Department of Pediatrics, Maimonides Medical Center, 977 48th Street, Brooklyn, NY, 11219, USA. Jkupferman@maimonidesmed.org.
authors: Juan C
authors: JC
authors: Kupferman
mesh_terms: D000959:Antihypertensive Agents / Q000627:therapeutic use; D001921:Brain / Q000000981:diagnostic imaging; D002400:Cathartics / Q000627:therapeutic use; D002648:Child; D003248:Constipation / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D005244:Fecal Impaction / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy; D006801:Humans; D006978:Hypertension, Renovascular / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D007441:Intubation, Gastrointestinal; D007668:Kidney / Q000000981:diagnostic imaging; D008279:Magnetic Resonance Imaging; D008297:Male; D011092:Polyethylene Glycols / Q000627:therapeutic use*; D054038:Posterior Leukoencephalopathy Syndrome / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*
chemical_list: D000959:Antihypertensive Agents; D002400:Cathartics; D011092:Polyethylene Glycols
keywords: Blood pressure; Brain; Fecal impaction; Hydronephrosis; Renal artery