Central Variant Posterior Reversible Encephalopathy Syndrome in an Infant: A Case Report
Aaron Hocher1, Sara Pavitt2
1Pediatric Neurosciences, University of Texas - Austin, 2University of Texas - Austin
Background:
A 12 month old, full term, healthy male presented with fever, hypertension (max: 174/140), altered mental status, and status epilepticus. His EEG demonstrated non-specific diffuse cerebral dysfunction and MRI brain demonstrated symmetric, bilateral T2 signal abnormalities involving the bilateral basal ganglia, periventricular white matter, centrum semiovale, medial thalamus, brainstem, and cerebellum. A metabolic screen and whole exome sequence was unremarkable. Initially, a metabolic etiology for his presentation was suspected given the symmetric, centrally located changes on brain imaging. However, further evaluation with CTA of the abdomen demonstrated bilateral renal artery stenosis, for which he underwent bilateral angioplasty and stenting. His neurologic symptoms resolved with strict blood pressure control and his MRI normalized after three months. These findings in the context of his clinical presentation was most suggestive of a central variant of posterior reversible encephalopathy syndrome (PRES).
Conclusions:
In infants, PRES may have an atypical imaging presentation given the differences in myelination pattern which may mimic metabolic conditions.
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