title: Posterior Reversible Encephalopathy Syndrome: A Comparative Study of Pediatric Versus Adult Patients.
abstract: Posterior reversible encephalopathy syndrome (PRES) is an acute neurotoxic syndrome that, although characteristically reversible, can result in long-term disability. Our aim was to identify the clinical and radiological factors that are unique to children with PRES compared with adults with the syndrome in a single center.
  
  
  
  We retrospectively reviewed the clinical and radiological records of all patients with PRES admitted at a tertiary care medical center from 2007 to 2014. All patients who met the clinical and radiological criteria for PRES were dichotomized into children (less than 18 years) and adults (18 years or older) based on their age groups, and comparison of their baseline variables, clinical, laboratory, and imaging features was performed.
  
  
  
  During this study period, 19 pediatric patients and 100 adult patients with PRES were identified. On univariate analysis, factors significantly associated with pediatric patients with the syndrome were multiorgan failure (84.2% vs 50%, P = 0.006), temporal lobe involvement (63.3% vs 39%, P = 0.04), restricted diffusion (42.1% vs 18%, P = 0.02), and less likelihood of cerebellar involvement (21.1% vs 57%, P = 0.004). On bivariate logistic regression analysis, all these factors remained significantly associated with pediatric PRES; multiorgan failure (odds ratio: 5.80, 95% confidence interval: 1.45 to 29.41, P = 0.03), temporal lobe involvement (odds ratio: 5.08, 95% confidence interval: 1.17 to 22.17, P = 0.03), restricted diffusion (odds ratio: 2.48, 95% confidence interval: 1.61 to 10.10, P = 0.02), and less likely to have cerebellar involvement (odds ratio: 0.08, 95% confidence interval: 0.002 to 0.39, P = 0.002).
  
  
  
  Factors unique to PRES in children compared with adults include a greater propensity with multi-organ failure, involvement of the temporal lobe, and restricted diffusion on imaging.
authors.affiliation: Department of Pediatric Neurology, Arkansas Children Hospital, Little Rock, Arkansas.
authors.forename: Kenneth
authors.initials: K
authors.lastname: Habetz
authors.affiliation: Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, Arkansas.
authors.forename: Raghu
authors.initials: R
authors.lastname: Ramakrishnaiah
authors.affiliation: Department of Community Medicine, Dr. Rajendra Prasad Government Medical College, Tanda, India.
authors.forename: Sunil Kumar
authors.initials: SK
authors.lastname: Raina
authors.affiliation: Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, Arkansas.
authors.forename: Ryan T
authors.initials: RT
authors.lastname: Fitzgerald
authors.affiliation: Department of Neurology, University of Arkansas for Medical Sciences, Little Rock, Arkansas; Department of Neurology, Ohio State University Wexner Medical Center, Columbus, Ohio. Electronic address: archanahinduja@yahoo.com.
authors.forename: Archana
authors.initials: A
authors.lastname: Hinduja
mesh_terms: D000328:Adult; D002648:Child; D002675:Child, Preschool; D057286:Electronic Health Records / Q000639:trends; D006801:Humans; D009102:Multiple Organ Failure / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000503:physiopathology; D054038:Posterior Leukoencephalopathy Syndrome / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000503:physiopathology*; D012189:Retrospective Studies; D013702:Temporal Lobe / Q000000981:diagnostic imaging; D055815:Young Adult
keywords: Hypertensive encephalopathy; PRES; Posterior reversible encephalopathy syndrome; imaging; pediatric