Clinical and neuroimaging findings in children with posterior reversible encephalopathy syndrome

Hiroyuki Yamamoto, Jun Natsume, Hiroyuki Kidokoro, Naoko Ishihara, Motomasa Suzuki, Takeshi Tsuji, Tetsuo Kubota, Akio Yamada, Michio Ozeki, Zenichiro Kato, Yoshiki Kawamura, Tetsushi Yoshikawa, Akihisa Okumura, Naoki Ando, Shinji Saitoh, Yoshiyuki Takahashi, Kazuyoshi Watanabe, Seiji Kojima

Research output: Contribution to journalArticle

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Abstract

Objective To clarify the clinical and radiological spectrum of posterior reversible encephalopathy syndrome (PRES) in children, and to identify the prognostic factors. Methods The records of 40 children with PRES were reviewed. Acute clinical symptoms, MRI including apparent diffusion coefficient (ADC) maps in the acute and follow-up periods and neurological sequelae, including epilepsy, were noted. Results Age at onset ranged from 2 to 16 years. Underlying disorders were hematological or neoplastic disorders (n = 20), renal diseases (n = 14) and others (n = 6). In the acute period, 31 patients had seizures, 25 had altered consciousness, 11 had visual disturbances and 10 had headache. Of 29 patients who had ADC maps in the acute period, 13 had reduced diffusivity as shown by ADC within PRES lesions. Of 26 patients with follow-up MRI, 13 had focal gliosis or cortical atrophy. No patients had motor impairment, and four patients had focal epilepsy. No clinical variables were associated with focal gliosis or cortical atrophy on follow-up MRI, but lesional ADC reduction in the acute period was prognostic for focal gliosis or cortical atrophy on follow-up MRI (p = 0.005). Conclusions To the best of our knowledge, this is the largest cohort study to date involving PRES in children. Acute symptoms in pediatric patients are similar to those reported in adults, but altered consciousness was more frequent in children. Lesional ADC reduction in the acute period was common and was a good predictor of later, irreversible MRI lesions.

Original languageEnglish
Pages (from-to)672-678
Number of pages7
JournalEuropean Journal of Paediatric Neurology
Volume19
Issue number6
DOIs
Publication statusPublished - 01-01-2015

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Posterior Leukoencephalopathy Syndrome
Neuroimaging
Gliosis
Atrophy
Consciousness
Partial Epilepsy
Age of Onset
Headache
Epilepsy
Seizures
Cohort Studies
Pediatrics
Kidney

All Science Journal Classification (ASJC) codes

  • Pediatrics, Perinatology, and Child Health
  • Clinical Neurology

Cite this

Yamamoto, H., Natsume, J., Kidokoro, H., Ishihara, N., Suzuki, M., Tsuji, T., ... Kojima, S. (2015). Clinical and neuroimaging findings in children with posterior reversible encephalopathy syndrome. European Journal of Paediatric Neurology, 19(6), 672-678. https://doi.org/10.1016/j.ejpn.2015.07.005
Yamamoto, Hiroyuki ; Natsume, Jun ; Kidokoro, Hiroyuki ; Ishihara, Naoko ; Suzuki, Motomasa ; Tsuji, Takeshi ; Kubota, Tetsuo ; Yamada, Akio ; Ozeki, Michio ; Kato, Zenichiro ; Kawamura, Yoshiki ; Yoshikawa, Tetsushi ; Okumura, Akihisa ; Ando, Naoki ; Saitoh, Shinji ; Takahashi, Yoshiyuki ; Watanabe, Kazuyoshi ; Kojima, Seiji. / Clinical and neuroimaging findings in children with posterior reversible encephalopathy syndrome. In: European Journal of Paediatric Neurology. 2015 ; Vol. 19, No. 6. pp. 672-678.
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author = "Hiroyuki Yamamoto and Jun Natsume and Hiroyuki Kidokoro and Naoko Ishihara and Motomasa Suzuki and Takeshi Tsuji and Tetsuo Kubota and Akio Yamada and Michio Ozeki and Zenichiro Kato and Yoshiki Kawamura and Tetsushi Yoshikawa and Akihisa Okumura and Naoki Ando and Shinji Saitoh and Yoshiyuki Takahashi and Kazuyoshi Watanabe and Seiji Kojima",
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Yamamoto, H, Natsume, J, Kidokoro, H, Ishihara, N, Suzuki, M, Tsuji, T, Kubota, T, Yamada, A, Ozeki, M, Kato, Z, Kawamura, Y, Yoshikawa, T, Okumura, A, Ando, N, Saitoh, S, Takahashi, Y, Watanabe, K & Kojima, S 2015, 'Clinical and neuroimaging findings in children with posterior reversible encephalopathy syndrome', European Journal of Paediatric Neurology, vol. 19, no. 6, pp. 672-678. https://doi.org/10.1016/j.ejpn.2015.07.005

Clinical and neuroimaging findings in children with posterior reversible encephalopathy syndrome. / Yamamoto, Hiroyuki; Natsume, Jun; Kidokoro, Hiroyuki; Ishihara, Naoko; Suzuki, Motomasa; Tsuji, Takeshi; Kubota, Tetsuo; Yamada, Akio; Ozeki, Michio; Kato, Zenichiro; Kawamura, Yoshiki; Yoshikawa, Tetsushi; Okumura, Akihisa; Ando, Naoki; Saitoh, Shinji; Takahashi, Yoshiyuki; Watanabe, Kazuyoshi; Kojima, Seiji.

In: European Journal of Paediatric Neurology, Vol. 19, No. 6, 01.01.2015, p. 672-678.

Research output: Contribution to journalArticle

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T1 - Clinical and neuroimaging findings in children with posterior reversible encephalopathy syndrome

AU - Yamamoto, Hiroyuki

AU - Natsume, Jun

AU - Kidokoro, Hiroyuki

AU - Ishihara, Naoko

AU - Suzuki, Motomasa

AU - Tsuji, Takeshi

AU - Kubota, Tetsuo

AU - Yamada, Akio

AU - Ozeki, Michio

AU - Kato, Zenichiro

AU - Kawamura, Yoshiki

AU - Yoshikawa, Tetsushi

AU - Okumura, Akihisa

AU - Ando, Naoki

AU - Saitoh, Shinji

AU - Takahashi, Yoshiyuki

AU - Watanabe, Kazuyoshi

AU - Kojima, Seiji

PY - 2015/1/1

Y1 - 2015/1/1

N2 - Objective To clarify the clinical and radiological spectrum of posterior reversible encephalopathy syndrome (PRES) in children, and to identify the prognostic factors. Methods The records of 40 children with PRES were reviewed. Acute clinical symptoms, MRI including apparent diffusion coefficient (ADC) maps in the acute and follow-up periods and neurological sequelae, including epilepsy, were noted. Results Age at onset ranged from 2 to 16 years. Underlying disorders were hematological or neoplastic disorders (n = 20), renal diseases (n = 14) and others (n = 6). In the acute period, 31 patients had seizures, 25 had altered consciousness, 11 had visual disturbances and 10 had headache. Of 29 patients who had ADC maps in the acute period, 13 had reduced diffusivity as shown by ADC within PRES lesions. Of 26 patients with follow-up MRI, 13 had focal gliosis or cortical atrophy. No patients had motor impairment, and four patients had focal epilepsy. No clinical variables were associated with focal gliosis or cortical atrophy on follow-up MRI, but lesional ADC reduction in the acute period was prognostic for focal gliosis or cortical atrophy on follow-up MRI (p = 0.005). Conclusions To the best of our knowledge, this is the largest cohort study to date involving PRES in children. Acute symptoms in pediatric patients are similar to those reported in adults, but altered consciousness was more frequent in children. Lesional ADC reduction in the acute period was common and was a good predictor of later, irreversible MRI lesions.

AB - Objective To clarify the clinical and radiological spectrum of posterior reversible encephalopathy syndrome (PRES) in children, and to identify the prognostic factors. Methods The records of 40 children with PRES were reviewed. Acute clinical symptoms, MRI including apparent diffusion coefficient (ADC) maps in the acute and follow-up periods and neurological sequelae, including epilepsy, were noted. Results Age at onset ranged from 2 to 16 years. Underlying disorders were hematological or neoplastic disorders (n = 20), renal diseases (n = 14) and others (n = 6). In the acute period, 31 patients had seizures, 25 had altered consciousness, 11 had visual disturbances and 10 had headache. Of 29 patients who had ADC maps in the acute period, 13 had reduced diffusivity as shown by ADC within PRES lesions. Of 26 patients with follow-up MRI, 13 had focal gliosis or cortical atrophy. No patients had motor impairment, and four patients had focal epilepsy. No clinical variables were associated with focal gliosis or cortical atrophy on follow-up MRI, but lesional ADC reduction in the acute period was prognostic for focal gliosis or cortical atrophy on follow-up MRI (p = 0.005). Conclusions To the best of our knowledge, this is the largest cohort study to date involving PRES in children. Acute symptoms in pediatric patients are similar to those reported in adults, but altered consciousness was more frequent in children. Lesional ADC reduction in the acute period was common and was a good predictor of later, irreversible MRI lesions.

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