Elsevier

Brain and Development

Volume 28, Issue 8, September 2006, Pages 544-546
Brain and Development

Case report
Posterior reversible encephalopathy syndrome in a child with bronchial asthma

https://doi.org/10.1016/j.braindev.2006.02.008Get rights and content

Abstract

Although posterior reversible encephalopathy syndrome (PRES) is caused by various conditions, there have been no reports on PRES associated with bronchial asthma. We report a case with PRES during the treatment for severe asthmatic attack. A 4-year-old girl was treated for asthmatic attack with steroids. From the 10th hospital day, hypertension, pulmonary edema, and cardiomegaly were observed. In spite of treatment with furosemide, she became lethargic and had a generalized convulsion on the 23rd hospital day. CT showed low density areas in the bilateral occipital white matter and MRI on the 28th hospital day demonstrated high intensity areas in the same regions on T2-weighted and FLAIR images. After discontinuation of corticosteroid and further antihypertensive therapy, her consciousness improved. MRI on the 67th hospital day had no abnormalities and no neurological sequelae were seen at 2 years after the event. We should be aware that PRES is a rare but important adverse event related to steroid therapy, because hypertension and water retention are major adverse effects of steroids.

Introduction

Posterior reversible encephalopathy syndrome (PRES) is a disorder usually associated with reversible radiological findings which involve the white matter and often gray matter of the parieto-occipital lobes, and characterized by seizures, altered mental state, visual abnormalities and headache [1], [2], [3]. It is caused by various conditions, including hypertension, eclampsia, immunosuppressive therapy, and renal failure. However, there have been no reports on PRES in children with bronchial asthma. We report a case with PRES which occurred during the treatment for severe asthmatic attack.

Section snippets

Patient report

A previously healthy 4-year-old girl presented with wheezing and dyspnea. She was diagnosed as having bronchial asthma and was hospitalized. Although she was treated with intravenous hydrocortisone, continuous inhalation of β-2 stimulator and supplementary oxygen, her respiration state became worse. On the 2nd hospital day, she was admitted to an intensive care unit and general anesthesia with inhaled sevoflurane was performed in combination with drip infusion of methylprednisolone at the dose

Discussion

The causes of PRES are diverse, and the majority of patients have clinically serious diseases or conditions such as renal failure, chemotherapy against malignancy, and immunosuppression for liver, renal, or bone marrow transplantation [1], [2], [3]. However, there have been no reports of PRES occurring during the treatment of asthmatic attack like this patient. Bronchial asthma is a common disease, and steroids are often used for the treatment. To our knowledge, there are few reports that the

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