Ref Number = PITIKA-ASPR0009
Ida Ayu Nyoman Dian Permana Hapsari, I Gusti Ngurah Made Suwarba, 
I Nyoman Budi Hartawan 
OBJECTIVE: Posterior reversible encephalopathy syndrome (PRES) is a condition characterized by varying degrees of headache, nausea, vomiting, visual disturbances, focal neurologic deficit, and seizures due to severe systemic hypertension characteristic by magnetic resonance imaging (MRI) findings as a gold standard diagnosis. This case have been reported occur at various ages ranging from 4 until 90 years, but true incidence in children is unknown. There is no specific treatment. Supportive treatment directed to symptoms is the mainstay of treatment. The prognosis is favorable as most cases completely resolve without any sequele.
CASE: A 9 year-old boy that presented with abdominal pain, headache, sudden blurred vission (visus 1/ 300), hypertensive crisis (blood pressure 150/110 mmHg), seizure and decrease of conciousness after seizure. Patient got nifedipine for hypertensive crisis and captopril, dexamethasone, phenytoin as supportive treatment. Blood pressure reached 95th percentile (115/75 mmHg) 10 hours after got the treatment with GCS E4V5M6 (15/15) and visus 5/5. MRI of the head found hyperintensity in T2W1 and flair in the cortical to subcortical left right parietooccipital lobe, suggesting a picture of vasogenic edema thus supporting the typical found of PRES. Patient was discharged at 7th day of hospitalization without any sequele. 
CONCLUSION: Posterior reversible encephalopathy syndrome should be considered in the differential diagnosis of children with unexplained seizure with hypertensive conditions. Patients with PRES suspicion, MRI examination must be done as a gold standard. Moreover, the early recognition of PRES would lead to effective treatment. The prognosis in patients with PRES is favorable as most cases completely resolve without any sequele.
Keywords: Posterior reversible encephalopathy syndrome, seizure, hypertensive condition, MRI, prognosis
Disclaimer: The Views and opinions expressed in the articles are of the authors and not of the journal.
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