Background: To date, there is a limitation of data to demonstrate the difference between PRES in children with and without renal disease. Previous studies showed that majority of children with PRES and hypertensive encephalopathy (HE) had underlying renal disease. The prognostic outcome of PRES is usually benign but there have been reports of longterm complications such as significant neurological deficits and epilepsy among these children.
Objectives: Our primary objective is to compare clinical manifestations, laboratory and neuroimaging findings of PRES in children who had underlying renal and non-renal disease. Our secondary objective is to compare clinical features of PRES and HE in children.
Material and Method: We retrospectively reviewed forty-three children with diagnosis of PRES or hypertensive encephalopathy form January 2009 to March 2019 at Pediatric department, Chiang Mai University Hospital. All data including clinical manifestations, laboratory finding, underlying medical illness and neuroimaging results were obtained.
Results: Twenty-three children were diagnosed with PRES, sixteen children with renal disease. Median age of onset was 10.3 years in children with renal disease and 9.8 years in children without renal disease. Hypertension was found 68.8% in renal disease and 42.8% in non-renal disease. At the onset of PRES, higher blood pressure on admission and history of uncontrolled hypertension were found in renal disease more than non-renal disease with statistical significance (p-value < 0.05). Seizures and neurological deficits were likely seen in renal disease group compared with non-renal disease group with statistical significance (p-value < 0.05). There was no difference in neuroimaging findings between these two groups. Compared with children with HE, children with PRES had a difference neuroimaging results with statistical significance. Both PRES and HE had seizures as their initial clinical symptoms. Generalized tonic clonic seizures were the most common seizure type (65.8%). Headache was more common in HE than PRES with statistical significance (p-value < 0.05). There were no differences in clinical outcomes between PRES and HE in recovery rate and death but PRES were prolong used anti-epileptic drug more than HE with statistical significant (p-value < 0.05).
Conclusion: Hypertension and history of uncontrolled blood pressure are more common in children with renal disease who developed PRES compared with non-renal disease. Seizures and neurological deficits are more common in PRES with renal disease group. There is no difference of neuroimaging findings of PRES in children with or without renal disease. All children with PRES are complete recovery without neurological deficits.
Keywords: posterior reversible encephalopathy, children, hypertension, hypertensive encephalopathy, renal disease
