The Long-Term Clinical Experience on PRES of A Tertiary Pediatric Neurology Center in Türkiye

Aim: This study evaluates the clinical and radiological characteristics, treatment approaches, and outcomes of pediatric patients diagnosed with Posterior Reversible Encephalopathy Syndrome (PRES) in a pediatric intensive care unit and hematology service. Materials and Methods: A retrospective analysis was conducted on 32 pediatric patients diagnosed with PRES between 2015 and 2023. Patients were followed up for at least two years. Demographic data, clinical features, and radiological findings were collected. EEGs were performed during the acute period and in follow-ups longer than three months. MRIs were evaluated by a multidisciplinary team. Vital signs were closely monitored, and blood pressure and intracranial pressure were managed. Results: Of the 32 patients, 9 were female (28%) and 23 were male (72%), aged between 26-214 months. The majority had undergone bone marrow transplantation (BMT), with 81% developing PRES post-transplant. Seizures were the most common symptom, occurring in 94% of cases. Antiepileptic drugs (AEDs) such as levetiracetam and clonazepam were used for seizure management. MRIs showed T2-weighted hyperintense lesions in all patients. The primary underlying conditions included acute lymphoblastic leukemia (ALL), chronic renal failure (CRF), and thalassemia major. Hypertension was present in all patients. Conclusion: The study highlights the high incidence of PRES in pediatric patients undergoing allogeneic hematopoietic stem cell transplantation (HSCT) and underscores the importance of early recognition and management of modifiable risk factors, particularly hypertension. Appropriate and timely intervention can significantly improve long-term outcomes for affected individuals. Further research is necessary to explore the pathophysiological mechanisms and optimize treatment strategies for PRES in pediatric populations.