Reversible posterior encephalopathy syndrome in a 10-year-old child.

Autor:	Carvalho EG; Universidade Federal de Viçosa, Departamento de Medicina e Enfermagem (DEM), Viçosa, MG, Brasil., Peluso HGC; Universidade Federal de Viçosa, Departamento de Medicina e Enfermagem (DEM), Viçosa, MG, Brasil., Batista LL; Universidade Federal de Viçosa, Departamento de Medicina e Enfermagem (DEM), Viçosa, MG, Brasil., Moreira CS; Universidade Federal de Viçosa, Departamento de Medicina e Enfermagem (DEM), Viçosa, MG, Brasil., Protti JSM; Universidade Federal de Viçosa, Departamento de Medicina e Enfermagem (DEM), Viçosa, MG, Brasil., Soares MCB; Universidade Federal de Viçosa, Departamento de Medicina e Enfermagem (DEM), Viçosa, MG, Brasil., Autran AFS; Universidade Federal de Viçosa, Departamento de Medicina e Enfermagem (DEM), Viçosa, MG, Brasil., Almeida ARS; Universidade Federal de Viçosa, Departamento de Medicina e Enfermagem (DEM), Viçosa, MG, Brasil., Rodrigues DC; Universidade Federal de Viçosa, Departamento de Medicina e Enfermagem (DEM), Viçosa, MG, Brasil., Bernardes LVGR; Universidade Federal de Viçosa, Departamento de Medicina e Enfermagem (DEM), Viçosa, MG, Brasil., Paula LP; Universidade Federal de Viçosa, Departamento de Medicina e Enfermagem (DEM), Viçosa, MG, Brasil.
Jazyk:	English; Portuguese
Zdroj:	Jornal brasileiro de nefrologia [J Bras Nefrol] 2019 Jul-Sep; Vol. 41 (3), pp. 436-439. Date of Electronic Publication: 2018 Sep 21.
DOI:	10.1590/2175-8239-JBN-2018-0111
Abstrakt:	Introduction: The posterior reversible encephalopathy (PRES) syndrome encompasses a set of clinical-radiological findings associated with severe systemic arterial hypertension. This case report proposes to discuss the identification, diagnosis, and management of PRES in the pediatric population. Case Presentation: Female patient, 10 years old, admitted to the emergency room with complaint of oliguria and generalized edema. At the initial physical exam, the only alteration present was anasarca. The diagnostic investigation revealed nephrotic syndrome, and clinical treatment was started. She evolved on the 8th day of hospitalization with peak hypertension, sudden visual loss, reduced level of consciousness, nystagmus, and focal seizures requiring intubation. She was transferred to the Intensive Care Unit, with neurological improvement, after the established therapy. CT scan revealed a discrete hypodense area in the white matter of the occipital lobe and anteroposterior groove asymmetry, compatible with PRES. Discussion: PRES is due to vasogenic cerebral edema of acute or subacute installation. Symptoms include headache and altered consciousness, stupor, coma, neurological deficits, seizures and cortical blindness. Nephropathies are the main cause of PRES in pediatrics. Magnetic resonance imaging with diffusion of molecules is the gold standard for diagnosis. The initial treatment objectives are the reduction of blood pressure, antiepileptic therapy, correction of hydroelectrolytic and acid-base disorders and management of intracranial hypertension. Conclusion: PRES is associated with acute hypertension. Early diagnosis and proper management may determine a better prognosis and minimize the severity of the clinical course.
Databáze:	MEDLINE
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