title: Difficulty in Distinguishing Posterior Reversible Encephalopathy Syndrome, Hypoxic-Ischemic Insult, and Acute Toxic Leukoencephalopathy in Children.
abstract: OBJECTIVE
  This study aims to describe our experience of unique pediatric neurological cases and associated difficulty in differentiating posterior reversible encephalopathy syndrome (PRES) from hypoxic-ischemic insult (HII), and acute toxic leukoencephalopathy (ATL).
  
  
  METHODS
  The study included three children with a clinical picture suggestive of PRES, HII, and ATL of different etiologies who were diagnosed and treated at a tertiary pediatric medical center in 2011 to 2014.
  
  
  RESULTS
  All patients presented with blindness following seizures with asphyxia/aspiration in a syndromatic child, too-rapid lipid infusion in a child with acute lymphoblastic leukemia, and repeated vomiting in a child with cerebral palsy, hydrocephalus, and malfunction of ventriculoperitoneal shunt. All patients had cortical blindness and high-signal foci in the cortical and subcortical regions on magnetic resonance imaging. All children improved.
  
  
  CONCLUSIONS
  Familiarity with the clinical and radiological characteristics of neurological conditions leading to reversible cortical blindness is essential for diagnosis and management. Distinguishing PRES from HII and ATL can be challenging. Our cases most likely combined these etiologies, with the first patient diagnosed with PRES with HII, the second with PRES with ATL, and the third with focal HII. Given the diversity of the findings and the unclear prognostic significance, studies of the pathophysiology of PRES are warranted.
authors.affiliation: Department of Radiology, Rabin Medical Center, Beilinson Campus, Petach Tikva, Israel.
authors.forename: Judith
authors.initials: J
authors.lastname: Luckman
authors.affiliation: Department of Ophthalmology, Rabin Medical Center, Beilinson Campus, Petach Tikva, Israel.
authors.forename: Alon
authors.initials: A
authors.lastname: Zahavi
authors.affiliation: Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Shai
authors.initials: S
authors.lastname: Efrati
authors.affiliation: Department of Pediatric Hemato-Oncology, Schneider Children's Medical Center of Israel, Petach Tikva, Israel.
authors.forename: Gil
authors.initials: G
authors.lastname: Gilad
authors.affiliation: Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Moshe
authors.initials: M
authors.lastname: Snir
authors.affiliation: Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Shalom
authors.initials: S
authors.lastname: Michowiz
authors.affiliation: Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Nitza
authors.initials: N
authors.lastname: Goldenberg-Cohen
mesh_terms: D002540:Cerebral Cortex / Q000473:pathology; D002675:Child, Preschool; D005260:Female; D006801:Humans; D002534:Hypoxia, Brain / Q000175:diagnosis*; D056784:Leukoencephalopathies / Q000139:chemically induced / Q000150:complications / Q000175:diagnosis*; D008297:Male; D059906:Neuroimaging; D054038:Posterior Leukoencephalopathy Syndrome / Q000175:diagnosis* / Q000209:etiology; D012189:Retrospective Studies