Abstract
Introduction: Posterior reversible encephalopathy syndrome (PRES) is a rare neurological disorder in children, characterized by distinctive clinical presentations and radiological findings, which may also be associated with renal conditions. We report an unusual case of reversible cortical blindness due to posterior reversible encephalopathy syndrome in a child with post-streptococcal glomerulonephritis (APSGN), highlighting the importance of early recognition and management.
Case presentation: A 9-year-old male with a recent diagnosis of pharyngotonsillitis presented to the hospital with persistent headache and vomiting. These symptoms were followed by transient visual loss and somnolence. Neurological examination revealed dysarthria, incoherent speech, ataxic gait, and cortical blindness. Blood pressure above the 95th percentile for his age led to the diagnosis of hypertensive emergency with cerebral target-organ damage. Antihypertensive therapy was initiated promptly. Laboratory tests demonstrated a positive Group A Streptococcus (GAS) antigen, along with proteinuria and hematuria, while abdominal computed tomography (CT) revealed kidney enlargement. These findings confirmed the diagnosis of post-streptococcal glomerulonephritis. Brain magnetic resonance imaging (MRI) demonstrated findings compatible with hypertensive leukoencephalopathy. Continuous blood pressure monitoring was maintained until optimal ranges were achieved, resulting in complete vision recovery. No neurological deficits were observed at the 20-week follow-up.
Discussion: Patients with posterior reversible encephalopathy syndrome present distinctive symptoms such as epileptic seizures, headaches, and visual disturbances, often mimicking other conditions, underscoring the importance of accurate diagnosis for timely intervention. Imaging findings are essential for confirming the diagnosis and guiding management.
Conclusions: This case highlights the importance of recognizing posterior reversible encephalopathy syndrome in pediatric patients. Appropriate and timely control of blood pressure contributed significantly to complete neurological recovery.
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