Abstract
Posterior reversible encephalopathy syndrome (PRES) is characterized by headache, abnormalities of mental status and visual perception, and seizures with radiological findings of symmetrical vasogenic edema that mainly involve the white matter of the parieto-occipital lobes. Although PRES is reversible when adequate managements are instituted, delayed diagnosis and therapy can result in irreversible neurological sequelae. Most cases of PRES occur in association with abnormal hypertension, and the favoured pathogenic theory for PRES suggests autoregulatory disturbance with hyperperfusion due to hypertension, causing a breakdown of the blood-brain-barrier and resulting in vasogenic edema. Since the first description of PRES in 1996 by Hinchey et al, as PRES has become better recognized, various situations have been identified, but few perioperative cases of pediatric patients have been reported yet. Here we report a case of 5-year-old boy with liver metastasis of Wilms' tumor presenting with PRES after partial hepatectomy possibly due to perioperative persistent hypertension, who was discharged without any subsequent neurological deficit with anti-hypertensive therapy and control of intracranial pressure. Strict managements of blood pressure and fluid balance should be considered in the perioperative settings of pediatric abdominal surgery as well due to the possible risk of PRES.
