Abstract
Posterior reversible encephalopathy syndrome (PRES) is a relatively new clinico-radiological entity first described as reversible posterior leukoencephalopathy syndrome in 1996. Originally, it denoted a reversible predominantly posterior leukoencephalopathy in patients who had renal insufficiency or hypertension or were immunosuppressed. Since then, there have been various reports on this syndrome in a variety of clinical settings, including pediatric patients.
In this review, we most emphasize the significance of early and precise diagnosis of PRES. Although its clinical and radiological courses have been reported as benign and reversible, a significant effect of early management on the prognosis of neurological function is suggested.
Classic neuroimaging applied to patients shows edema involving the white matter in the posterior portions of the cerebral hemispheres, especially bilaterally in the parietooccipital regions. We have shown, however, radiological abnormalities extended to the gray matter, frontal and temporal lobes, and even the cerebellum. Thus, posterior reversible encephalopathy syndrome should be suspected in pediatric kidney transplant recipients and patients with kidney disease if they have a sudden episode of neurological symptoms, even if imaging findings are not restricted to the subcortical white matter of the occipital region.
We also review the management of PRES, including the treatment of hypertension and seizures as well as the discontinuance and re-administration of calcineurin inhibitors.
