Adv Pediatr Surg.  2023 Dec;29(2):83-88. 10.13029/aps.2023.29.2.83.

Posterior Reversible Encephalopathy Syndrome (PRES) Following Abdominal Surgery for Adrenal Neuroblastoma in a Pediatric Patient: A Unique Case Report AND Therapeutic Insights

• Murali A
• Kothandan BT
• Radhakrishnan V
• Raja A

• KMID: 2551548
• DOI: http://doi.org/10.13029/aps.2023.29.2.83

Abstract

Posterior reversible encephalopathy syndrome (PRES) is a distinctive neurological disorder characterized by specific clinical and radiological features. While its etiology is multifaceted, the vasogenic theory provides a comprehensive framework for understanding its pathogenesis. Notably, PRES has been observed in cancer patients undergoing cytotoxic chemotherapy, immunotherapy, and select neurosurgical interventions. In this context, we present an unprecedented case involving a 7-year-old girl who developed PRES subsequent to abdominal surgery for adrenal neuroblastoma, a scenario hitherto unreported in medical literature. The patient’s medical history encompasses a diagnosis of stage IV neuroblastoma - high risk. Her treatment course comprised six cycles of neoadjuvant chemotherapy, followed by an open right adrenalectomy coupled with retroperitoneal lymph node dissection. Following surgery, the patient’s clinical profile evolved to encompass the classic symptoms of PRES, including headache, blurred vision, and elevated blood pressure. Neuro-imaging confirmed the diagnosis, with subsequent robust clinical recovery achieved by day 12. Continuation of adjuvant therapy in accordance with established protocols was pursued. Successful management of PRES pivots on several crucial principles: timely recognition, meticulous hydration, vigilant blood pressure control, and attentive intensive care. By adhering to these tenets, complete clinical recuperation can be realized, sparing patients enduring neurological deficits or vision impairment. This case underscores the importance of remaining vigilant for PRES in postoperative settings, particularly in pediatric patients undergoing surgical interventions for malignancies. Further studies and vigilance are warranted to expand our understanding of this intriguing condition and optimize therapeutic strategies.

Keyword

Posterior reversible encephalopathy syndrome; Surgery; Neuroblastoma; Adrenalectomy; Cancer