RECURRENT POSTERIOR REVERSIBLE ENCEPHALOPATHY SYNDROME IN CHRONIC KIDNEY DISEASE

Dr.Geeta Karambelkar; Dr.Sharad Agarkhedkar; Dr.Arpit Gupta

Volume : VI, Issue : VIII, August - 2016

RECURRENT POSTERIOR REVERSIBLE ENCEPHALOPATHY SYNDROME IN CHRONIC KIDNEY DISEASE

Dr. Geeta Karambelkar, Dr. Sharad Agarkhedkar, Dr. Arpit Gupta

Abstract :

Posterior reversible encephalopathy syndrome (PRES) is a clinical syndrome of encephalopathy, headache, visual disturbance, and seizures. One essential feature of PRES is the presence of reversible cereal vasogenic edema that has a predominantly posterior distribution on ain imaging. In most cases, both clinical and radiological findings are reversible, although permanent imaging abnormalities and residual neurological sequelae can be seen in a minority of patients. Treatment of hypertension and seizures, and withdrawal of causative agents are the mainstays of therapy in PRES. Chronic kidney disease patients may be especially vulnerable to this syndrome because they are frequently exposed to several of its possible causes, including uremia and hypertension. In its most severe form, PRES can manifest clinically as seizures, coma or death. However, if properly diagnosed and treated, this syndrome can be completely reversible. We report the case of a very young hypertensive chronic kidney disease patient, ought to the emergency room with headache and left tonic–clonic seizures; the cereal magnetic resonance imaging features were impressive. Anti–hypertensive therapy and Peritoneal Dialysis allowed complete recovery including complete resolution of follow–up MRI. Recurrence though uncommon was observed in the child who was now on Continous Ambulatory Peritoneal Dialysis after 5 months of initial episode. Timely diagnosis and therapy led to complete reversal of PRES and therefore it should be kept in mind in the differential diagnosis of consciousness impairment, seizure activity, headache or visual abnormality in chronic kidney disease patients. Prompt correction of the cause is crucial to decrease the risk of ischemia or bleeding and therefore to avoid permanent disability or death.