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Childhood posterior reversible encephalopathy syndrome: Magnetic resonance imaging findings with emphasis on increased leptomeningeal FLAIR signal.
Neuroradiol J. 2015 Dec; 28(6):638-43.NJ

Abstract

PURPOSE

Posterior reversible encephalopathy syndrome (PRES) is a clinico-radiologic syndrome characterized clinically by headache, seizures, and altered sensorium and radiological changes which are usually reversible. The purpose of this study was to describe the spectrum of magnetic resonance imaging (MRI) findings in childhood PRES, to determine the common etiologies for childhood PRES, and to have an insight into the pathophysiology of PRES.

METHODS

The MRI results of 20 clinically diagnosed cases of PRES between July 2011 and June 2013 were reviewed. The final diagnosis of PRES was based on the clinical presentation and the MRI features at the time of presentation, which resolved on the follow-up imaging. The medical records of the patients were reviewed to determine the underlying medical disease.

RESULTS

Eight out of the 20 patients included in the study were on cyclosporine or tacrolimus based immunosuppressant therapy for kidney transplant. Four patients had severe hypertension at presentation. The most common MRI finding was high T2-fluid-attenuated inversion recovery (FLAIR) signal in the cortex and subcortical white matter of both cerebral hemispheres, particularly in the parietal and occipital lobes (n=16). The second most common MRI finding was increased leptomeningeal FLAIR signal (n=7). Out of seven patients with leptomeningeal signal, five demonstrated leptomeningeal enhancement as well. Four out of these seven patients had no other parenchymal findings.

CONCLUSION

Childhood PRES is commonly seen in the setting of immunosuppressant therapy for kidney transplant, severe hypertension and cancer treatment. There was high incidence of increased leptomeningeal FLAIR signal and leptomeningeal enhancement in our study. It supports the current theory of endothelial injury with increased microvascular permeability as the potential pathophysiology of PRES. Also, absence of elevated blood pressure in majority of the patients in our study supports the theory of direct endothelial injury by some agents leading to vasogenic edema.

Authors+Show Affiliations

Department of Radiology, University of Missouri, Columbia, MO, USA draajay@gmail.com.Department of Nephrology, Children's Hospital of Michigan, Detroit, MI, USA.Department of Radiology, Children's Hospital of Michigan, Detroit, MI, USA.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

26515749

Citation

Agarwal, Ajay, et al. "Childhood Posterior Reversible Encephalopathy Syndrome: Magnetic Resonance Imaging Findings With Emphasis On Increased Leptomeningeal FLAIR Signal." The Neuroradiology Journal, vol. 28, no. 6, 2015, pp. 638-43.
Agarwal A, Kapur G, Altinok D. Childhood posterior reversible encephalopathy syndrome: Magnetic resonance imaging findings with emphasis on increased leptomeningeal FLAIR signal. Neuroradiol J. 2015;28(6):638-43.
Agarwal, A., Kapur, G., & Altinok, D. (2015). Childhood posterior reversible encephalopathy syndrome: Magnetic resonance imaging findings with emphasis on increased leptomeningeal FLAIR signal. The Neuroradiology Journal, 28(6), 638-43. https://doi.org/10.1177/1971400915609338
Agarwal A, Kapur G, Altinok D. Childhood Posterior Reversible Encephalopathy Syndrome: Magnetic Resonance Imaging Findings With Emphasis On Increased Leptomeningeal FLAIR Signal. Neuroradiol J. 2015;28(6):638-43. PubMed PMID: 26515749.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Childhood posterior reversible encephalopathy syndrome: Magnetic resonance imaging findings with emphasis on increased leptomeningeal FLAIR signal. AU - Agarwal,Ajay, AU - Kapur,Gaurav, AU - Altinok,Deniz, Y1 - 2015/10/29/ PY - 2015/10/31/entrez PY - 2015/10/31/pubmed PY - 2016/2/2/medline KW - Magnetic resonance imaging KW - childhood KW - encephalopathy KW - posterior reversible encephalopathy syndrome SP - 638 EP - 43 JF - The neuroradiology journal JO - Neuroradiol J VL - 28 IS - 6 N2 - PURPOSE: Posterior reversible encephalopathy syndrome (PRES) is a clinico-radiologic syndrome characterized clinically by headache, seizures, and altered sensorium and radiological changes which are usually reversible. The purpose of this study was to describe the spectrum of magnetic resonance imaging (MRI) findings in childhood PRES, to determine the common etiologies for childhood PRES, and to have an insight into the pathophysiology of PRES. METHODS: The MRI results of 20 clinically diagnosed cases of PRES between July 2011 and June 2013 were reviewed. The final diagnosis of PRES was based on the clinical presentation and the MRI features at the time of presentation, which resolved on the follow-up imaging. The medical records of the patients were reviewed to determine the underlying medical disease. RESULTS: Eight out of the 20 patients included in the study were on cyclosporine or tacrolimus based immunosuppressant therapy for kidney transplant. Four patients had severe hypertension at presentation. The most common MRI finding was high T2-fluid-attenuated inversion recovery (FLAIR) signal in the cortex and subcortical white matter of both cerebral hemispheres, particularly in the parietal and occipital lobes (n=16). The second most common MRI finding was increased leptomeningeal FLAIR signal (n=7). Out of seven patients with leptomeningeal signal, five demonstrated leptomeningeal enhancement as well. Four out of these seven patients had no other parenchymal findings. CONCLUSION: Childhood PRES is commonly seen in the setting of immunosuppressant therapy for kidney transplant, severe hypertension and cancer treatment. There was high incidence of increased leptomeningeal FLAIR signal and leptomeningeal enhancement in our study. It supports the current theory of endothelial injury with increased microvascular permeability as the potential pathophysiology of PRES. Also, absence of elevated blood pressure in majority of the patients in our study supports the theory of direct endothelial injury by some agents leading to vasogenic edema. SN - 1971-4009 UR - https://www.unboundmedicine.com/medline/citation/26515749/Childhood_posterior_reversible_encephalopathy_syndrome:_Magnetic_resonance_imaging_findings_with_emphasis_on_increased_leptomeningeal_FLAIR_signal_ L2 - https://journals.sagepub.com/doi/10.1177/1971400915609338?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -