Skip to main content

Advertisement

SpringerLink
Log in

Constipation, renovascular hypertension, and posterior reversible encephalopathy syndrome (PRES)

  • Case Report
  • Published:
European Journal of Pediatrics Aims and scope Submit manuscript

Abstract

Posterior reversible encephalopathy syndrome (PRES) is a clinico-radiological entity characterized by variable associations of headaches, encephalopathy, seizures, vomiting, visual disturbance, and focal neurological signs. Neuroimaging shows cerebral edema of different patterns, classically involving the parieto-occipital white matter. PRES has been associated with several conditions predominantly hypertension, eclampsia, and immunosuppressive therapy. However, constipation has not been previously described in association with the development of PRES. In this report, we describe an 11-year-old child with history of severe functional constipation who developed PRES, as a consequence of renovascular hypertension from severe fecal impaction. Both hypertension and neurologic dysfunction resolved after resolution of fecal impaction.

Conclusion: Severe functional constipation is a previously unrecognized cause of severe acute hypertension, resulting in life-threatening neurologic dysfunction. We highlight this unrecognized complication of severe functional constipation with fecal impaction that is potentially preventable if managed appropriately.

What is Known:

• Posterior reversible encephalopathy syndrome (PRES) is a life-threatening disorder

• PRES has been associated with multiple conditions, including hypertension and immunosuppressive therapy

What is New:

• Constipation with severe fecal impaction may cause severe renovascular hypertension and PRES

• Severe functional constipation is a previously unrecognized cause of severe symptomatic hypertension that could result in acute brain dysfunction, such as PRES

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

Abbreviations

°F:

Degrees Fahrenheit

ALT:

Alanine aminotransferase

AST:

Aspartate aminotransferase

BP:

Blood pressure

cm:

Centimeter

g/dL:

Gram per deciliter

kg:

Kilogram

mcL:

Microliter

mg/dL:

Milligram per deciliter

min:

Minutes

mmHg:

Millimeters of mercury

mmol/L:

Millimol per liter

MRA:

Magnetic resonance angiography

MRI:

Magnetic resonance imaging

ng/mL/h:

Nanogram per milliliter per hour

PRES:

Posterior reversible encephalopathy syndrome

U/L:

Units per liter

References

  1. Benoist G, Dossier C, Elmaleh M, Dauger S (2013) Posterior reversible encephalopathy syndrome revealing renal artery stenosis in a child. BMJ Case Rep

  2. Hinchey J, Chaves C, Appignani B, Breen J, Pao L, Wang A, Pessin MS, Lamy C, Mas JL, Caplan LR (1996) A reversible posterior leukoencephalopathy syndrome. N Engl J Med 334:494–500

    Article  CAS  PubMed  Google Scholar 

  3. Ishikura K, Hamasaki Y, Sakai T, Hataya H, Mak RH, Honda M (2012) Posterior reversible encephalopathy syndrome in children with kidney diseases. Pediatr Nephrol 27:375–384

    Article  PubMed  Google Scholar 

  4. Lee VH, Wijdicks EF, Manno EM, Rabinstein AA (2008) Clinical spectrum of reversible posterior leukoencephalopathy syndrome. Arch Neurol 65:205–210

    PubMed  Google Scholar 

  5. Marchal AL, Hoeffel JC, Freyd S, Schmitt M, Olive D, Fays J (1986) Arterial hypertension caused by extrinsic compression of the renal artery of tumor origin in a child. Pediatrie 41:475–480

    CAS  PubMed  Google Scholar 

  6. Raissaki MMA, Katzilakis N, Stiakaki E, Kalmanti M (2012) Posterior reversible encephalopathy syndrome in a child with neuroblastoma. Pediatr Radiol 42:S532

    Google Scholar 

  7. Sharma M, Kupferman JC, Brosgol Y, Paterno K, Goodman S, Prohovnik I, Kirkham FJ, Pavlakis SG (2010) The effects of hypertension on the paediatric brain: a justifiable concern. Lancet Neurol 9:933–940

    Article  PubMed  Google Scholar 

  8. Tabbers MM, DiLorenzo C, Berger MY, Faure C, Langendam MW, Nurko S, Staiano A, Vandenplas Y, Benninga MA (2014) Evaluation and treatment of functional constipation in infants and children: evidence-based recommendations from ESPGHAN and NASPGHAN. J Pediatr Gastroenterol Nutr 58:258–274

    CAS  PubMed  Google Scholar 

  9. Tullus K, Roebuck DJ, McLaren CA, Marks SD (2010) Imaging in the evaluation of renovascular disease. Pediatr Nephrol 25:1049–1056

    Article  PubMed Central  PubMed  Google Scholar 

  10. Vaughan CJ, Delanty N (2000) Hypertensive emergencies. Lancet 356:411–417

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgments

We thank Karen Sorensen, MLS, reference librarian at the D. Samuel Gottesman Libraryof the Albert Einstein College of Medicine, for her assistance with the literature search.

Conflict of interest

Dr. Prasad declares that she has no conflict of interest, Dr. Wetzler declares that she has no conflict of interest, Dr. Holtmann declares that she has no conflict of interest, Dr. Dapul declares that she has no conflict of interest, Dr. Kupferman has received a consulting honorarium from Alexion Pharmaceuticals.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was not required by the institutional review board for the purpose of this case report.

Authors’ Contributions

Dr Prasad made substantial contribution to acquisition of data, drafted the initial manuscript, and approved the final manuscript as submitted.

Drs. Wetzler, Holtmann, and Dapul made substantial contributions to analysis and interpretation of data, critically reviewed and revised the manuscript, and approved the final manuscript as submitted.

Dr. Kupferman made substantial contribution to conception, design and analysis of interpretation of data, critically reviewed and edited the manuscript, and approved the final manuscript as submitted.

Author information

Authors and Affiliations

  1. Department of Pediatrics, Maimonides Medical Center, 977 48th Street, Brooklyn, NY, 11219, USA

    Malavika Prasad, Graciela Wetzler, Julia Holtmann, Heda Dapul & Juan C. Kupferman

Authors
  1. Malavika Prasad
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Graciela Wetzler
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Julia Holtmann
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Heda Dapul
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Juan C. Kupferman
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Juan C. Kupferman.

Additional information

Communicated by Beat Steinmann

All authors approved the final manuscript as submitted.

Electronic supplementary material

Below is the link to the electronic supplementary material.

ESM 1

(DOCX 18 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Prasad, M., Wetzler, G., Holtmann, J. et al. Constipation, renovascular hypertension, and posterior reversible encephalopathy syndrome (PRES). Eur J Pediatr 175, 421–425 (2016). https://doi.org/10.1007/s00431-015-2627-0

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00431-015-2627-0

Keywords

Search

Navigation