Posterior reversible encephalopathy syndrome in a child with cyclical vomiting and hypertension: a case report

Abstract

Introduction: Posterior reversible encephalopathy syndrome is characterized by headache, nausea and vomiting, seizures and visual disturbances. It has certain characteristic radiological features, which allow diagnosis in the appropriate clinical setting and enable appropriate clinical therapy to be instituted.

Case presentation: A 10-year-old Caucasian girl who was hospitalized due to recurrent vomiting was diagnosed as having posterior reversible encephalopathy syndrome after an initial diagnosis of cyclical vomiting and hypertension was made.

Conclusion: Posterior reversible encephalopathy syndrome is a rare disorder in children. Early recognition of characteristic radiological features is key to the diagnosis as clinical symptoms may be non-specific or mimic other neurological illnesses. To the best of our knowledge this is the first case to report an association between posterior reversible encephalopathy syndrome, cyclical vomiting and hypertension. Furthermore, in this case, the resolution of the abnormalities found on magnetic resonance imaging over time did not appear to equate with clinical recovery.

Figure 1

Coronal fluid attenuation inversion recovery (FLAIR) MRI through the posterior brain showing bilateral patchy areas of high signal within the subcortical white matter of right occipital lobe and left parietal lobe.

Figure 2

T2 sagittal MRI through a right paracentral position showing multiple subcortical white matter lesions in the right temporal lobe anteriorly, and the right occipital lobe posteriorly.