Background

Posterior reversible encephalopathy syndrome (PRES) is classically a reversible clinical radiographic syndrome associated with predominantly posterior leukoencephalopathy on neuroimaging. Magnetic resonance imaging (MRI) in adults demonstrates almost universally reversible parietal-occipital disease. We aimed to demonstrate in a cohort of children that “atypical” distribution is expected, acutely and on follow-up.

Methods

A retrospective review of children diagnosed with PRES from 2010 to 2018 at our children's hospital was performed. All had MRI at diagnoses, with over half having follow-up MRIs. Images were reviewed by a neuroradiology-trained pediatric radiologist for confirmation of findings consistent with PRES/identification of involved regions.

Results

Nineteen patients (aged zero to 18 years, 53% female) were included. Notably, two were infants. Nearly all had seizures; all had altered mental status and hypertension. Fifteen (84%) had MRI described as “atypical.” Distribution of MRI findings was anatomically widespread, including nine with frontal findings. Twelve (63%) had follow-up imaging, of which approximately half remained abnormal.

Conclusions

Pediatric PRES MRI findings were more often atypical at time of diagnosis. Vasogenic edema related to the acute phases of PRES typically resolved; however, follow-up imaging identified new volume loss in the areas affected. Two of our subjects were younger than 13 months, younger than typically described. Our series demonstrates that imaging distribution in children with PRES does not mirror the classical posterior, reversible distribution described in adults and continues the recent trend of identifying PRES in infants.

中文翻译：

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新生儿和儿童可逆性后部脑病综合征 (PRES) 的影像学表现与成人不同

背景

可逆性后部脑病综合征（PRES）是一种典型的可逆性临床放射学综合征，与神经影像学上的主要后部白质脑病相关。成人磁共振成像 (MRI) 显示几乎普遍可逆的顶枕骨疾病。我们的目的是在一组儿童中证明“非典型”分布是预期的，并且是敏锐的和后续的。

方法

对我院儿童医院2010年至2018年诊断为PRES的儿童进行回顾性分析。所有人在诊断时均进行了 MRI 检查，其中一半以上进行了后续 MRI 检查。受过神经放射学培训的儿科放射科医生对图像进行了审查，以确认与 PRES/相关区域的识别一致的结果。

结果

纳入 19 名患者（年龄 0 至 18 岁，53% 女性）。值得注意的是，其中两个是婴儿。几乎所有人都出现了癫痫发作；所有人都有精神状态改变和高血压。十五 (84%) 的 MRI 被描述为“非典型”。MRI 发现的分布在解剖学上很广泛，其中 9 个有额叶发现。十二人（63%）进行了随访影像学检查，其中大约一半仍然异常。

结论

诊断时，儿科 PRES MRI 结果往往不典型。与 PRES 急性期相关的血管源性水肿通常会得到缓解；然而，后续成像发现受影响区域出现新的体积损失。我们的两名受试者年龄不到 13 个月，比通常描述的要小。我们的系列研究表明，儿童 PRES 的影像学分布并不反映成人中描述的经典后验、可逆分布，而是延续了最近识别婴儿 PRES 的趋势。