Seizures in children with high blood pressure

Background - PRES (posterior reversible encephalopathy syndrome) is a clinical-radiological entity characterised by a combination of neurological signs and symptoms and neuroradiological alterations like subcortical and cortical vasogenic oedema that is bilateral and symmetric and mainly involves the posteriors regions of cerebral hemispheres. Currently, two theories exist about the pathophysiology of PRES; these theories identify arterial hypertension and endothelial injury induced by an inflammatory process or immune disorders as trigger factors of PRES. The signs and symptoms associated with PRES are also common to other diseases of CNS, like ischemic or haemorrhagic events, infections, neoplasia, metabolic diseases and epilepsy. These diseases have to be considered in the differential diagnosis process. PRES is associated with a wide range of clinical conditions, namely transplantations, immunosuppressive therapy, chemotherapy, autoimmune diseases, infections and hypertension. As these groups of patients are more predisposed to the onset of PRES, the encephalopathy should be taken into consideration and the right exams should be prescribed in order to diagnose it. In this case brain MRI represents the gold standard for the diagnosis. PRES is generally a reversible and benign condition, nevertheless severe complications with poor clinical outcomes can occur. Methods - The paper describes PRES peculiar aspects including a curios clinical case of PRES associated to a massive consumption of glycyrrhizic acid coming from liquorice sweets that Paolo (a 10-year-old boy) had been eating in high quantity every day since 4 months, unaware that his blood pressure would have increased until the onset of an encephalopathy that luckily had been solved without permanent outcomes. Conclusion - It is essential to know patients' categories that are at high risk of encephalopathy and suspect PRES at an early stage to start an appropriate treatment and avoid severe complications.