Clinical Analysis Of Posterior Reversible Encephalopathy Syndrome After Allogeneic Hematopoietic Stem Cell Transplantation In Children

Objective: To analyze and summarize the clinical characteristics of posterior reversible encephalopathy syndrome after allogeneic hematopoietic stem cell transplantation in children,so as to facilitate prevention,early diagnosis and early treatment,and reduce the risk of life and quality of life of children after transplantation.Methods: A retrospective analysis of the general information,onset time,symptoms,auxiliary examinations and prognosis of 17 children with PRES who were admitted to the Pediatrics Department of the First Affiliated Hospital of Guangxi Medical University from January 20,2015 to May 20,2020 Happening.Results: 1.From January 20,2015 to May 20,2020,the Department of Pediatrics in our hospital admitted 133 children with allo-HSCT.A total of 17 children had PRES,and the incidence of PRES was 12.8%.Among the 17 children,11 were males(64.7%)and 6 were females(35.7%).The median age of PRES was 7(5-10)years.The median time to occurrence of PRES after transplantation was 42(27.5-66.5)days after transplantation,of which 15 cases(88.2%)of children had PRES within 100 days after transplantation.The cumulative incidence of PRES at 30 days,100 days,and 1 year after transplantation was 3.8%,11.3%,and 12.8%,respectively.2.All the 17 children with PRES had acute onset and convulsions,and 9(52.9%)had headache.One(5.9%)had dizziness,one(5.9%)had blurred vision,and one(5.9%)had gibberish.Of the 16 cases,15(93.8%)had elevated blood pressure,and 1(5.9%)had normal blood pressure.3.Hyponatremia occurred in 4 cases(26.7%).Cerebrospinal fluid(CSF)was examined in 14 children,and all CSF cell counts and CSF glucose were basically normal;protein levels were slightly increased in 2 cases(14.3%);no bacteria,fungi and acid-fast bacilli were found in CSF smear of 14 children,and no abnormal conditions were found in culture.EEG examination was completed in 5 cases,including 1 case(20%)with boundary EEG and poor occipital rhythm,while the remaining 4 cases(80%)mainly showed slower background activity and increased δθ activity mainly in occipital area.4.Eleven of the children received cranial CT plain scan,2 cases(18.2%)showed low density lesions,and the remaining 9 cases(81.8%)showed no obvious abnormality on cranial CT plain scan.Brain MRI examination was performed in 15 children.The lesions were mainly located in the parietoccipital lobe(80%),followed by the frontal lobe(53.3%)and temporal lobe(53.3%).Most lesions were bilateral,and a few were unilateral.The lesions also involved cerebellum(26.7%),basal ganglia(13.3%),corona radiata(13.3%),external capsule(6.7%),center of semiovale(6.7%),etc.The lesions presented slightly lower,equal,slightly longer or long T1 WI signal,slightly longer,slightly higher or long T2 WI signal,and FLAIR presented slightly higher or high signal.5.After the symptomatic treatment,such as blood pressure control,sedation,dehydration and reducing cranial pressure,all the 17 children developed recurrent convulsions in 1 year follow-up and was diagnosed as epilepsy,but the symptoms of the rest were improved.There were 7 children reexamined with craniocerebral MRI,of which 5 cases had completely disappeared and 2 cases had reduced lesions.Conclusion: 1.The incidence of PRES after allo-HSCT in children was12.8%,most of which occurred within 100 days after transplantation;2.The main clinical manifestations of PRES after allo-HSCT in children were hypertension,convulsion and headache;3.When neurological symptoms occur in children with allo-HSCT,PRES is suspected to be diagnosed by cranial MRI examination as soon as possible;4.The prognosis of PRES after allo-HSCT in children is good with prompt diagnosis and early treatment.