Abstracts

Rationale: Seizures occur in 70 to 78 % of adults with PRES syndrome. Visual hallucinations have been reported in 3 to 5% of adult cases. Bizarre visual hallucinations have not been previously reported in children with PRES syndrome. Methods: Case report and literature review Results: An 11 year old female had a generalized tonic clonic seizure 5 days after an exploratory abdominal laparoscopic following a previous complicated appendectomy. She was initially treated with Lorazepam. As she continued to have frequent partial complex seizures with eye deviation to the right, Levetiracetam and Fosphenytoin were started. The next day, as she regained consciousness the following bizarre seizures were noted: sudden gravitational hallucinations (falling sensation), autokinesis (soap dispenser staring at her), prosopometamorphopsia (family members look like Patrick), inverted vision (I'm upside down), aschematia (legs and feet do not belong to me), micropsia (sky scrapers in the room) and metamorphopsias (colorful circles or star fish everywhere). These hallucinations disappeared 6 days after initiation of treatment. Epileptic activity on EEG were found to correlate with hallucinations. Conclusions: Bizarre hallucinations correlating with seizure activity appear to be a new feature of PRES syndrome. We postulate that children are more prone to develop vivid and bizarre visual hallucinations in PRES syndrome.