Abstract Ref Number = APCP1070
REVERSIBLE ENCEPHALOPATHY FOLLOWING ACUTE POST-STREPTOCOCCAL GLOMERULONEPHRITIS IN 8-YEARS-OLD INDONESIAN GIRL.
Eka Airlangga,Rina Yunita,Yeni Halim
University of Muhammadiyah Sumatra Utara University of Sumatra Utara Imelda General Hospital, Medan
Background : Encephalopathy following Acute Post-streptococcal Glomerulonephritis (APSGN) is not commonly happened, as seizure and altered mental status signs frequently put the infection of central nervous system as the first diagnosis.
Case Presentation Summary : The 8-years-old Indonesian girl was brought to private hospital in Medan and treated as central nervous system (CNS) infection because of her general seizure and altered mental status. During our examination, it was found that she got history of facial edema, mild hypertension (blood pressure 160/80 mmHg), pupil reflexes was still normal and no signs of meningeal reflexes and pathologic’ reflexes. Her complete blood count revealed mild anemia, leukocytosis and normal count of thrombocyte. Urinalysis result showed-up hematuria and proteinuria. Blood gas analysis and electrolyte level was in normal. Her head CT-scan revealed cerebral edema located in parieto-occipital area. We then treated her as APSGN with encephalopathy or Posterior Reversible Encephalopathy Sindrome (PRES). Following several days, she was then discharged and took control to outpatient clinic.
Learning Points/Discussion : Encephalopathy in APSGN patient is unusual manifestation, but so far there were several cases reported for APSGN and encephalopathy as Posterior reversible encephalopathy syndrome (PRES). However APSGN is not the only one which causes PRES.1,2 A sudden rise of blood pressure overcomes the normal autoregulation of cerebral blood flow and causes dilatation of the cerebral arterioles, resulting in brain hyperperfusion. This increased perfusion pressure can overcome the blood-brain barrier, resulting to cerebral edema (vasogenic edema). Computed tomography (CT) scan reveals nonenhancing hypodensities of cerebral white matter in bilateral parietooccipital lobes.3 Meanwhile, abnormal findings of Cranial CTs meningoencephalitis were edema, hydrocephalus, hemorrhage, subfalcine herniation, and dural venous thrombosis and almost 18% had a normal acute CT and abnormal findings identified on MRI performed within 2 days.4 History of minimal edema, hematuria and hypertension and encephalopathy supported the diagnosis of PRES after APSGN.
Keywords: encephalopathy APSGN PRES children