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Título

POSTERIOR REVERSIBLE ENCEPHALOPATHY SYNDROME (PRES) IN PEDIATRICS – 2 REPORT CASES AND LITERATURE REVIEW

Apresentação do caso

A 9-year-old female patient undergoing treatment for type B acute lymphoblastic leukemia, without central nervous system involvement. She was undergoing chemotherapy treatment. Two weeks after the methotrexate (MTX) infusion, she developed an episode of amaurosis, followed by a lowered level of consciousness and generalized tonic-clonic motor seizures.
During the diagnostic investigation, an MRI was performed showing extensive areas of hypersignal on T2/FLAIR asymmetrically affecting the parieto-occipital cortico-subcortical regions, as well as the left temporal lobe and the middle frontal gyri and part of the superior frontal gyri, in the central aspect of the pons, in the right frontal periventricular region and on the posterior aspect of the splenium of the corpus callosum. Small foci of hemosiderin deposits - subcortical corticoid microhemorrhages sparse across the above-described signal alteration zones. The set of changes confirmed posterior reversible encephalopathy (PRES).
A 15-year-old male patient was hospitalized due to status epilepticus associated with arterial hypertension. Under investigation, severe chronic kidney disease was diagnosed, requiring hemodialysis. He evolved with severe hypertension that was difficult to control, seizures, and bilateral visual deficits. The MRI exam also showed a pattern compatible with PRES.

Discussão

Posterior reversible encephalopathy syndrome (PRES) is an acute neuroradiologic diagnosis that presents headache, vomiting, seizures, mental confusion, visual disturbances, ataxia, encephalopathy, and other neurologic abnormalities. It is associated with some etiologies, of which the use of immunosuppressive drugs and arterial hypertension are the most frequent. Although PRES is usually reversible and most patients recover fully with the resolution of the imaging findings, its early diagnosis and prompt treatment are essential for the reduction of morbidity and mortality in these patients.

Comentários finais

It is very important for pediatric intensivists and neurologists to consider PRES syndrome in patients with risk factors for the development of the condition. This allows for an early diagnosis and approach, reducing the morbidity and mortality rates of these patients.

Referências (se houver)

ARADILLAS, E.; ARORA, R.; GASPERINO J. Methotrexate-Induced Posterior Reversible Encephalopathy Syndrome. Journal of Clinical Pharmacy and Therapeutics, v.36, p. 529–536, 2011.

PAVLIDOU, E. et al. Posterior reversible encephalopathy syndrome after intrathecal methotrexate infusion: a case report and literature update. Quant Imaging Med Surg, v.6, n.5,p.605-611,2016.

MAZHAR, S. Incidence of Methotrexate induced Posterior Reversible Encephalopathy Syndrome in Pediatric Cancer Patients; A Case Series from a Tertiary Care Hospital, Pakistan. Int J Cancer Res Mol Mech, v.4, n.1, 2018.

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