Background:
Posterior Reversible Encephalopathy Syndrome (PRES) is a rare neurological disorder with a wide range of neurological presentations and causes. Children may be more likely to suffer from cerebrovascular dysregulation than adults, because the range of autoregulation of cerebral blood flow is relatively narrow. A systematic review of pediatric groups with PRES indicates that 85% of children are hypertensive.
Results:
Herein, we report a 9-year-old boy with a known history of ADHD and chronic insomnia, who exhibited a sudden onset of altered mental status, characterized by disorientation and an inability to follow commands. MRI brain imaging demonstrated multifocal supratentorial hyperintensities on T2/FLAIR sequences with diffusion restriction. Further evaluation with echocardiography, mitochondrial studies, and cerebral spinal fluid analysis, was unremarkable. Repeat MRI brain after 4 days of presentation showed significant interval improvement in the T2/Flair hyperintensities. BP at presentation was >95 %ile of patient’s age and height and subsequent detailed history suggested likely Clonidine withdrawal induced hypertension causing the atypical radiographic presentation of PRES.
Conclusions:
This case emphasizes the importance of recognizing atypical presentations of PRES in pediatric patients, including the involvement of multifocal brain regions and diffusion restriction on MRI. Furthermore, it highlights the significance of managing clonidine withdrawal and supporting patients through the resolution of PRES, which, in this case, resulted in the normalization of blood pressure and the gradual improvement of the patient's neurological symptoms.