Early Warning And Intervention Studies Of Posterior Reversible Encephalopathy Syndrome In Children

Objective:Posterior reversible encephalopathy syndrome (PRES) is a clinico-radiologic disorder. How to diagnose it earlier is an important clinical work.Method:This study is divided into four parts. First stage:retrospective analysis of the medical records of patients in five medical centers who were clinically diagnosed with PRES (2001-2013) in China was performed. Second stage:A further retrospective EEG review of patients with PRES in first stage was performed; Third stage:The PDC scale was developed based on results obtained from our first two parts of research and literature. To evaluate the specificity of the PDC, we evaluated data of 17 children diagnosed with PRES who underwent a MRI and EEG. We compared them with 15 children who were finally diagnosed with viral encephalitis or lupus encephalopathy. Fourth stage:During treatment of patients who were diagnosed with acute lymphoblastic leukemia preliminary, monitoring the EEG of patients and using the PDC scale to make prediction and early intervention for patients who probably have PRES.Result:①Seizure, which was the most common clinical sign, occurred in 29 patients (93.5%). Cerebral imaging abnormalities were bilateral and predominant in the parietal and occipital white matter. Three patients died, and three patient developed long-term sequelae. PRES patients with hematologic tumor manifested a worse prognosis than patients without the disorder. ②Slowing of background activity was seen in all patients. Diffuse theta/delta slowing was the most frequent finding, in 52.9% patients.③PRES was correctly diagnosed from the PDC score in 29 of 31 patients, with a sensitivity of 0.97 (95% confidence interval [CI],0.88-1.06), specificity of 0.87(95% CI,0.73-1.01),positive predictive value of 0.89 (95% CI, 0.77-1.01, and negative predictive value of 0.93 (95% CI,0.82-1.04). ④Slowing of background activity was seen in 16 of 57 children who were clinically diagnosed with acute leukemia at second to third week of chemotherapy. The PDC score was above 10 in 3 children at third to fourth week of chemotherapy.Conclusion:①Seizure was a prevalent characteristic of children with PRES. Poor prognosis was observed in PRES patients with hematologic tumor. ②Slowing of the background is common EEG sign for PRES. Its presence in the correct clinical context should raise a strong suspicion of the diagnosis.③Clinicians should pay attention to patients whose PDC score is above 10.