Abstracts

Rationale: PRES is a rare but distinct clinico-radiological entity observed in children. Cases are commonly associated with malignant hypertension, toxemia in pregnancy and use of immunosuppressive agents, who present with non specific symptoms of headache, mental change, visual loss or seizures. The purpose of this paper is to discuss the three cases of children with PRES who presented with seizure as their initial manifestation. Methods: Case review Results: (Case-1) 11 years old girl with unresectable hepatoblastoma who received cisplatin, vincristine and 5 FU. Two days later complained of dizziness, blurring of vision followed by six tonic clonic seizures controlled with Lorazepam and Phenobarbital. Her CT showed bilateral white matter lesions in parieto-occipital cortex, consistent with PRES, which showed minimal resolution in CT done at 2 and 4 weeks. CT done at 3 months showed complete resolution. (Case-2) 17 year old female who presents with four episodes of generalized seizures. She delivered a baby child 5 days ago. There was no eclampsia or preeclampsia but she developed post partum hypertension. EEG showed left occipital status epilepticus. MRI showed hyperintensity in subcortical white matter of the parietal, occipital, and dorsal frontal lobes, consistent with PRES. Repeat MRI done after 3 months showed complete resolution of lesions. (Case-3) 7 year boy with post transplantation lymphoproliferative disorder, secondary to cardiac transplant for dilated cardiomyopathy, who received recent chemotherapy treatments, presented with acute onset altered sensorium. EEG showed status over the left occipital head region. MRI revealed hyperintensity in bilateral parietal and frontal lobes with restricted diffusion. Repeat MRI done at one month showed complete resolution. Conclusions: Clinicians should be aware of seizures as the first manifestation of PRES, as early recognition is essential for appropriate investigation and management.