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Severe posterior reversible encephalopathy syndrome resolved with craniectomy
Author(s) -
Nagaoka Yoshinobu,
Ishikura Kenji,
Hamada Riku,
Miyagawa Tadashi,
Kono Tatsuo,
Sakai Tomoyuki,
Hamasaki Yuko,
Hataya Hiroshi,
Honda Masataka
Publication year - 2013
Publication title -
pediatrics international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.49
H-Index - 63
eISSN - 1442-200X
pISSN - 1328-8067
DOI - 10.1111/ped.12084
Subject(s) - medicine , posterior reversible encephalopathy syndrome , decompressive craniectomy , encephalopathy , radiology , magnetic resonance imaging , traumatic brain injury , psychiatry
Posterior reversible encephalopathy syndrome ( PRES ) has been thought to be a benign disease, but recently severe cases have been reported with increasing recognition. A 3‐year‐old girl with congenital nephrotic syndrome had rapidly progressed to coma. Computed tomography ( CT ) of the head showed striking swelling of the brainstem and transtentorial herniation. Emergency decompressive craniectomy was performed. Consecutively, blood pressure was optimally controlled. The patient gradually recovered to the previous state before onset of PRES. Rapid improvement of clinical symptoms and rapid resolution of abnormal findings on serial CT led to diagnosis of PRES . In severe PRES with unstable vital signs, surgical intervention should be considered as well as appropriate blood pressure management.