Summary

A 14-year-old girl was admitted to the emergency department for repeated seizures with no fever. High blood pressure at admission was ascribed to the status epilepticus. Seizure recurrence promoted transfer to the paediatric intensive care unit. The MRI visualised bilateral, subcortical, white-matter lesions in the parietal and occipital lobes suggesting posterior reversible encephalopathy syndrome (PRES). Continuous nicardipine infusion corrected the hypertension and neurological manifestations within a few hours. The diagnostic workup showed right renal artery stenosis. Blood pressure returned to normal values for age after right nephrectomy. She was discharged home without treatment. She had no residual neurological impairments. This case highlights the risk of misinterpreting sustained hypertension in children with repeated seizures. We briefly review paediatric PRES, which is rare as compared to adults. Increased awareness among critical care physicians, together with greater availability of cerebral MRI, is decreasing the time to diagnosis.