Clinical and radiological features of posterior reversible encephalopathy syndrome in children: a retrospective study

Background Posterior reversible encephalopathy syndrome (PRES) is an uncommon but critical neurological emergency in children. Data on Chinese pediatric cohorts remain limited. Objective To analyze the clinical features, imaging findings, and treatment of PRES in children to improve early diagnosis and management. Methods A retrospective analysis was conducted on 10 children diagnosed with PRES from March 2016 to January 2025. Results The patients included 7 males and 3 females, aged 3–13 years (mean 7.5 years). The main underlying diseases were acute lymphoblastic leukemia (3 cases) and nephrotic syndrome (3 cases). Eight children (80%) had hypertension, 6 (60%) had hypoalbuminemia, and 8 received glucocorticoids or immunosuppressants. The main symptoms were headache, seizures, impaired consciousness, and visual disturbances. Cranial MRI showed symmetrical long T1 and long T2 signals in bilateral posterior cerebral white matter. After comprehensive treatment including antihypertensive, anticonvulsant, and dehydration therapy, all symptoms resolved and lesions disappeared on follow-up imaging without sequelae. Conclusion Pediatric PRES is an acute reversible disorder associated with hypertension and immunosuppressive therapy. Early MRI diagnosis and prompt intervention can significantly improve prognosis.