Atypical presentation of posterior reversible encephalopathy: in a child with bilateral grade IV vesicoureteric reflux

J Trop Pediatr. 2014 Aug;60(4):331-3. doi: 10.1093/tropej/fmu019. Epub 2014 Apr 3.


Posterior reversible encephalopathy, better known as potential reversible encephalopathy syndrome (PRES), is a clinicoradiological entity mostly described in adult populations manifesting predominantly as bilateral symmetrical diffuse white matter vasogenic oedema in parieto-occipital regions. Rarely it may also present as patchy reversible areas of involvement in the basal ganglia, brainstem and deep white matter. It is reported scarcely in childhood populations. Frequent association with acute hypertension (67-80%) is reported in many studies. Involvement of the brainstem and cervical cord (apart from the typical parieto-occipital lesions) is an extremely rare imaging manifestation of PRES and its recognition is important to avoid misdiagnosis as myelitis or acute disseminated encephalomyelitis by proper clinical correlation. We hereby report a case of PRES in a 7-year-old child showing an uncommon pattern on imaging study involving the brain as well as the brainstem and cervical spinal cord.

Keywords: Brainstem; cervical cord; children; posterior reversible encephalopathy.

Publication types

  • Case Reports

MeSH terms

  • Anticonvulsants / therapeutic use
  • Antihypertensive Agents / therapeutic use
  • Child
  • Humans
  • Hypertension / drug therapy
  • Magnetic Resonance Imaging
  • Medulla Oblongata / pathology*
  • Posterior Leukoencephalopathy Syndrome / pathology*
  • Spinal Cord / pathology*
  • Treatment Outcome


  • Anticonvulsants
  • Antihypertensive Agents