ABSTRACT
Posterior reversible encephalopathy syndrome (PRES) is a rare disease attributed to an increase in blood pressure that exceeds the autoregulatory capabilities of the cerebral vasculature, resulting in brain edema. Although PRES primarily affects adults, the pediatric population is also at risk. Radiologists must be aware of that risk because the imaging features on brain MRI are often atypical, especially in pediatric patients. Over a 6-year period, nine pediatric patients were diagnosed with PRES at our institution. Here, those patients are evaluated retrospectively regarding demographic characteristics, clinical profiles, imaging aspects, and outcomes. In this pictorial essay, we review the typical and atypical imaging findings of PRES in pediatric patients, demonstrating that it should be considered in patients with a clinical profile suggestive of the diagnosis, given that prompt, effective treatment is important for full recovery, thus avoiding major morbidity and mortality in such patients.
A síndrome de encefalopatia posterior reversível (PRES) é uma doença rara relacionada com uma falha no mecanismo autorregulatório vascular, resultando em edema cerebral. Apesar de primariamente descrita em adultos, a população pediátrica encontra-se em igual risco de desenvolver esta condição e o radiologista deve estar atento porque frequentemente a ressonância magnética apresenta características de imagem atípicas. Em um período de seis anos, nove pacientes pediátricos com o diagnóstico de PRES foram avaliados, retrospectivamente, no que diz respeito a sua demografia, antecedentes médicos, características de imagem e prognóstico. Neste ensaio analisamos características de imagem típicas e atípicas de pacientes pediátricos com o diagnóstico de PRES, mostrando que este diagnóstico deve ser considerado quando está presente um quadro clínico adequado, uma vez que o tratamento rápido e eficaz é importante para a recuperação completa, evitando morbimortalidade maior neste grupo etário.
ABSTRACT
Abstract Posterior reversible encephalopathy syndrome (PRES) is a rare disease attributed to an increase in blood pressure that exceeds the autoregulatory capabilities of the cerebral vasculature, resulting in brain edema. Although PRES primarily affects adults, the pediatric population is also at risk. Radiologists must be aware of that risk because the imaging features on brain MRI are often atypical, especially in pediatric patients. Over a 6-year period, nine pediatric patients were diagnosed with PRES at our institution. Here, those patients are evaluated retrospectively regarding demographic characteristics, clinical profiles, imaging aspects, and outcomes. In this pictorial essay, we review the typical and atypical imaging findings of PRES in pediatric patients, demonstrating that it should be considered in patients with a clinical profile suggestive of the diagnosis, given that prompt, effective treatment is important for full recovery, thus avoiding major morbidity and mortality in such patients.
Resumo A síndrome de encefalopatia posterior reversível (PRES) é uma doença rara relacionada com uma falha no mecanismo autorregulatório vascular, resultando em edema cerebral. Apesar de primariamente descrita em adultos, a população pediátrica encontra-se em igual risco de desenvolver esta condição e o radiologista deve estar atento porque frequentemente a ressonância magnética apresenta características de imagem atípicas. Em um período de seis anos, nove pacientes pediátricos com o diagnóstico de PRES foram avaliados, retrospectivamente, no que diz respeito a sua demografia, antecedentes médicos, características de imagem e prognóstico. Neste ensaio analisamos características de imagem típicas e atípicas de pacientes pediátricos com o diagnóstico de PRES, mostrando que este diagnóstico deve ser considerado quando está presente um quadro clínico adequado, uma vez que o tratamento rápido e eficaz é importante para a recuperação completa, evitando morbimortalidade maior neste grupo etário.
ABSTRACT
ABSTRACT: Various diseases that impact different systems and organs in the body may trigger manic episodes. Strokes are often associated with psychiatric symptoms, particularly depressive and, more rarely, manic. We herein report a case of bipolar disorder secondary to cerebrovascular disease in a 67-year-old man with no personal or family history of psychiatric illness who, at the age of 64, had a bilateral ischemic stroke in the middle cerebral artery territory. About 20 days after this stroke, he experienced a manic episode. Three years later, he experienced a second manic episode, with another hospitalization in a psychiatric ward. With this case, we intend to emphasize that, although rare, the diagnosis of mania after stroke should not be forgotten, and most important, one should be aware of the recurrence of affective episodes just as in non-medical-caused bipolar disorder.
Subject(s)
Bipolar Disorder/etiology , Ischemic Stroke/complications , Mania/etiology , Aged , Humans , Infarction, Middle Cerebral Artery/complications , MaleABSTRACT
Desmoid tumours are rare locally aggressive mesenchymal tumours with a high local recurrence rate, particularly in the head and neck locations. We present the case of a 5-year-old child with a locally invasive inoperable desmoid tumour of the masticator space who underwent a low-dose chemotherapy regimen for 17 months, obtaining a long-term complete response. Definitive evidenced-based treatment guidelines are lacking. Therefore, paediatric patients should be managed by specialised multidisciplinary teams to try to achieve the best tumour control while minimising treatment associated morbidity and mortality. Available treatment options include surgery, radiotherapy and different systemic medical therapies. Whereas traditionally, surgery was the mainstay of treatment, more conservative options have increasingly shown adequate tumour control with little associated morbidity. In this decision making it is mandatory to take into account the patient's age, tumour location and extension, and potential short-term and long-term treatment-related sequelae to minimise functional and cosmetic compromise.
