Hüseyin ÇAKSEN, Hüseyin TOKGÖZ, Gülsüm ALKAN, Serhat EMEKSİZ, Nurettin Onur KUTLU, Hülya Şeker YIKMAZ

Çocuklarda posterior reversible ansefalopati sendromu: olgu serisi

Posterior reversibl ansefalopati sendromu hipertansiyon, nöbet (konvulsiyon), baş ağrısı, bilinç bulanıklığı ve görme bozukluğu ile giden ve manyetik rezonans görüntülemede belirgin lezyonlarla tanısı konulan bir durumdur. Ocak 2010 ve Ocak 2014 tarihleri arasında Meram Tıp Fakültesi çocuk yoğun bakım ve hematoloji servislerinde izlenen beş posterior reversibl ansefalopati sendromu olgusu geriye dönük olarak değerlendirildi. Demografik ve klinik özellikleri ve görüntüleme bulguları gözden geçirildi. Olguların birincil hastalıkları; akut lenfositik lösemi (iki hasta), Henoch-Schönlein purpurası (bir hasta), sistemik lupus eritematozus (bir hasta) ve poststreptokoksik akut glomerülonefritti (bir hasta). Ortalama yaş 10±4,58 yıldı (5-14 yıl). Kan basıncının yüksekliği tüm hastalarda vardı. Başlangıç nörolojik belirtiler; nöbet, bilinç bulanıklığı, baş ağrısı ve görme bozukluğuydu. Klinik değerlendirme ve manyetik rezonans görüntüleme ile tanı konulduktan sonra uygun tedavi yaklaşımı ile tüm hastalarda klinik iyileşme sağlandı. Sonuç olarak, ansefalopati tablosu ile gelen ve zemininde nefrit, vaskülit ve malinite; kliniğinde kan basıncı yüksekliği ve ilaç kullanımı olan olgularda ayırıcı tanıda posterior reversibl ansefalopati sendromu düşünülmelidir.

Posterior reversible encephalopathy syndrome in children: a case series

Posterior reversible encephalopathy syndrome is characterized by hypertension, seizure, headache, clouding of consciousness, and visual disturbance, and is diagnosed in the presence of typical lesions on magnetic resonance imaging. We retrospectively evaluated five patients who were diagnosed as having posterior reversible encephalopathy syndrome and followed up in Meram Medical Faculty, Pediatric Intensive Care and Hematology wards, between January 2010 and January 2014. We reviewed the demographic and clinical data, and neuroimaging findings. The primary diseases of the subjects included acute lymphocytic leukemia (n=2), Henoch-Schönlein purpura (n=1), systemic lupus erythematous (n=1), and acute poststreptococcal glomerulonephritis (n=1). The mean age was 10±4.58 years (range, 5-14 years). Acute elevation of blood pressure was found in all patients (n=5). Initial neurologic manifestations included seizure, clouding of consciousness, headache, and visual disturbance. After the diagnosis was made through clinical evaluations and magnetic resonance imaging, complete clinical recovery was obtained in all patients with the appropriate therapeutic approach. In conclusion, posterior reversible encephalopathy syndrome should be considered in the differential diagnosis of patients who present with encephalopathy and underlying diseases such as nephritis, vasculitis, malignancy accompanied by hypertension, and a history of use of medication.

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