Posterior Reversible Encephalopathy Syndrome (Pres) Following Peritonitis in a Child

Posterior Reversible Encephalopathy Syndrome (Pres) Following Peritonitis in a Child | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report Posterior Reversible Encephalopathy Syndrome (Pres) Following Peritonitis in a Child Servais Sontia SAI, Koffi Isidore KOUAME, Kouadio Antoine KOUAME, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9349548/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 8 You are reading this latest preprint version Abstract The variability of clinical presentations and the absence of an obvious etiology may delay the diagnosis of Posterior Reversible Encephalopathy Syndrome (PRES) in pediatric patients, particularly in resource-limited settings. We report the case of a 12-year-old girl admitted to the intensive care unit for peritonitis secondary to ileal perforation, whose postoperative course was complicated by refractory convulsive status epilepticus associated with bilateral cortical blindness. The diagnosis of PRES was confirmed by brain MRI, which demonstrated bilateral parieto-occipital vasogenic edema with hemorrhagic stigmata. Despite a prolonged visual recovery (65 days), the overall outcome was favorable. This case highlights that PRES should be considered in any acute neurological presentation occurring in a septic context — including in the absence of hypertension — and that early diagnosis and etiological management are key determinants of neurological outcome. Figures Figure 1 KEY POINTS PRES should be considered in any acute neurological picture following sepsis, including in paediatrics. Inflammatory endothelial dysfunction can induce PRES without hypertension; its absence alone does not rule out the diagnosis. Early and optimal management of underlying sepsis remains the cornerstone of therapy. Any treatment delay may promote more severe forms and prolonged recovery. INTRODUCTION Posterior Reversible Encephalopathy Syndrome (PRES) is a neurological entity with diverse clinical manifestations [ 1 – 2 ]. In the absence of specific clinical signs, diagnosis relies primarily on brain Magnetic Resonance Imaging (MRI), which reveals vasogenic oedema predominantly in the white matter of the occipital lobes and sometimes the parietal lobes [ 1 ]. Although initially described in adults, PRES can also occur in the paediatric population.[ 3 – 7 ] The at-risk populations for this radio-clinical syndrome are well established [ 1 ]. More recently, sepsis has been identified as an independent risk factor, with a few cases reported in the literature [ 8 – 9 ]. While paediatric PRES cases associated with sepsis have been described, those occurring in the context of sepsis of digestive origin remain rare [ 3 – 5 ]. In sub-Saharan Africa, and particularly in Côte d'Ivoire, this entity does not appear to have been documented in paediatric intensive care settings, likely due to diagnostic constraints [ 10 ]. We report here a case of PRES revealed by seizures and blindness in an adolescent girl admitted for acute peritonitis that was managed late. CASE PRESENTATION A 12-year-old adolescent girl with no significant medical history, residing in a rural area, was admitted to the paediatric emergency department for abdominal pain syndrome associated with unmeasured prehospital fever and altered general condition, evolving for approximately two weeks. The diagnosis was peritonitis with signs of dehydration. While awaiting surgery, the patient experienced two seizures treated with two 5 mg doses of midazolam, prompting her admission to the Intensive Care Unit (ICU). On admission, clinical examination revealed arterial hypertension (160/90 mmHg), tachycardia (92 bpm), and mild jaundice. There was altered consciousness (Glasgow Coma Scale score of 10 — E2V2M6 —) with intermittent agitation and choreiform movements. No sensorimotor deficits or meningeal signs were noted. Respiratory status was stable (SpO₂: 96% on room air). Laboratory investigations showed severe hypoglycaemia (0.3 g/L), renal dysfunction, signs of hepatocellular insufficiency, and severe metabolic acidosis (Table 1 ). Initial management included emergency glucose administration, rehydration, broad-spectrum antibiotics (piperacillin-tazobactam and amikacin), blood transfusion, and vitamin K1 supplementation. Exploratory laparotomy, performed approximately six hours after ICU admission, revealed a single ileal perforation without mesenteric adenolymphitis. A segmental ileal resection with diverting stoma was carried out. In the immediate postoperative period, the patient remained agitated with persistent choreiform movements and intermittent bruxism. These neurological disturbances, combined with renal dysfunction and oedema, raised suspicion of uraemic encephalopathy. Two haemodialysis sessions were performed, improving consciousness (Glasgow 15) and renal function (see Table 1 ), but with no notable effect on agitation or hypertension (systolic blood pressure 140–160 mmHg). On postoperative day 10, the course was marked by refractory seizures unresponsive to midazolam and the onset of bilateral blindness. Seizures were controlled with the addition of levetiracetam. Brain MRI showed hyperintensity in the cortical white matter without restricted apparent diffusion coefficient (ADC), consistent with vasogenic oedema. Lesions were diffuse, bilateral, symmetrical, predominantly parieto-occipital with associated cerebellar involvement. They showed no enhancement after gadolinium administration. Rare hypointense foci on susceptibility-weighted sequences indicated haemorrhagic stigmata (Fig. 1 ). PRES was diagnosed, and intravenous nicardipine was initiated for blood pressure control, targeting systolic blood pressure below 140 mmHg. The patient stayed 17 days in the ICU before transfer to paediatric surgery, where gastrointestinal continuity was later restored. The outcome was favourable, with no seizure recurrence. Full visual recovery occurred after approximately 65 days. Table 1 Summary of the kinetics of biological parameters during the clinical course of our patient Parameters (units) Admission D2 D10 (Post-RRT) D20 in ICU Normal values WBC (cells/mm³) 24,800 30,400 17,800 9,910 [4,000–10,000] Hb (g/dL) 11.8 12.3 8.9 10.2 Hct (%) 34 36.5 26.9 34.7 [36–46] Platelets (cells/mm³) 121,000 180,000 367,000 257,000 [150,000–400,000] Natremia (mEq/L) 130 129 136 143 [135–145] Kalemia (mEq/L) 5.1 5.4 3.79 3.57 [3.5–5.0] Chloremia (mEq/L) 91 86 99 105 [95–105] Calcemia (mg/L) 87 — — 78 [88–104] Magnesemia (mg/L) 19 — — 14 [17–24] CRP (mg/mL) 234 98 46 — < 6 PCT (ng/mL) 65.88 — 12 — < 0.5 ASAT (IU/L) 108 89 — — < 40 ALAT (IU/L) 67 31 — — < 40 Urea (g/L) 2.28 3.38 0.49 0.38 [0.15–0.45] Creatinine (mg/L) 57 80 28 12 [7–13] pH 7.12 7.34 7.40 — [7.38–7.42] PaO₂ (mmHg) 95 101 102 — [80–100] PaCO₂ (mmHg) 27.5 25 32 — [35–45] HCO₃ (mmol/L) 10.4 13.5 22 — [22–26] Lactate (mmol/L) 5.6 3.8 0.7 — ≤ 2 Abbreviations: RRT: Renal Replacement Therapy — Hb: Hemoglobin — Hct: Hematocrit — CRP: C-Reactive Protein — PCT: Procalcitonin — WBC: White Blood Cells — D: Day — ICU: Intensive Care Unit Table 2: Comparative bioclinical and outcome characteristics of pediatric PRES cases secondary to sepsis of gastrointestinal origin Parameters Our case Saley [3] Rafee [5] Age 12 years 5 years 11 years Sex Female Female Male Medical history None None None Gastrointestinal lesion Ileal perforation Perforated appendicitis Perforated appendicitis Identified organisms Not specified E. coli , B. fragilis E. coli , P. aeruginosa , S. constellatus , Bacteroides Delay before admission ≈ 2 weeks Prompt 7 days Hypertension at admission Grade 2 Grade 2 Grade 2 Organ dysfunction Acute kidney injury Pulmonary edema None Seizures Yes Yes Yes Visual disturbances Yes (Cortical blindness) No No Hemorrhage on MRI Yes No No Antiepileptic treatment Benzodiazepine, Levetiracetam Benzodiazepine, Fosphenytoin Lorazepam Antihypertensive treatment IV Nicardipine None Oral Isradipine Time to recovery 65 days 25 days — DISCUSSION We report a case of posterior reversible encephalopathy syndrome (PRES) in an adolescent following acute peritonitis due to ileal perforation, revealed by status epilepticus associated with transient cortical blindness. To our knowledge, this is one of the few paediatric cases of PRES secondary to sepsis of digestive origin reported in sub-Saharan Africa. The rarity of this association warrants comparison with the literature and discussion of the underlying pathophysiological mechanisms. Pathophysiology The pathophysiology of PRES, though not fully elucidated, involves two main mechanisms [1–8]. The most commonly described involves severe arterial hypertension exceeding cerebral autoregulation capacity, leading to cerebral hyperperfusion and endothelial dysfunction with blood-brain barrier (BBB) disruption. This promotes vasogenic oedema formation. The second mechanism, implicated in sepsis, involves inflammatory endothelial dysfunction. Here, proinflammatory mediators—particularly immunomodulatory and cytotoxic agents—directly impair the BBB independently of hypertension. This is observed in PRES cases without hypertensive context. Thus, regardless of the underlying aetiology, endothelial dysfunction and subsequent BBB alteration appear as the common denominator leading to cerebral vasogenic oedema. Both mechanisms appear intertwined in our patient. Microbiology The lack of microbiological documentation of peritoneal fluid is a notable limitation of our observation. Nevertheless, given the high prevalence of Salmonella typhi as the aetiological agent of ileal perforations in our setting, a typhoid origin remains the most likely hypothesis, though it cannot be formally confirmed. Onset Timing In our patient, the initial preoperative seizures in the context of severe hypoglycaemia cannot be attributed to PRES, complicating precise determination of symptom onset. However, considering postoperative day 5—marked by refractory seizures with bilateral blindness—as the clinical revelation point, our case stands out by its earlier onset [5–12]. This may be explained by the estimated two-week delay in initial management. Clinical Features Paediatric PRES most often occurs in children without prior history, in a sepsis context, with neurological manifestations dominated by seizures. These are the primary mode of revelation and frequently progress to status epilepticus, especially in younger patients [13]. Consciousness may remain preserved, as in our case. The onset of bilateral cortical blindness was the most striking feature here. Reported in 20–39% of PRES cases [1], it remains rare in paediatrics and, in our patient, resulted from bilateral occipital cortical vasogenic oedema on MRI, without anterior optic pathway involvement. Concomitant acute kidney injury initially suggested uraemic encephalopathy. Its dismissal after two haemodialysis sessions without neurological improvement underscores the need to consider PRES in the differential diagnosis of any unexplained acute neurological picture in sepsis, even with potentially explanatory organ failure. Therapeutic Aspects Management of our patient focused on seizure control, blood pressure management, and treatment of underlying sepsis. Antiepileptic therapy followed standard status epilepticus protocols [11]. First-line benzodiazepine (midazolam) was followed by a long-acting antiepileptic (levetiracetam), selected for its favourable profile: cardiorespiratory safety and lack of significant sedation, ideal for neurological monitoring in ICU. Intravenous nicardipine was chosen as the antihypertensive due to its availability, targeting progressive systolic blood pressure reduction [12]. However, its positive chronotropic effect is a limitation in some haemodynamic contexts, where labetalol may be a better alternative if available. Notably, antihypertensives were not required in some septic PRES cases [3], highlighting the need to tailor blood pressure strategy to the individual patient profile. Outcome Our patient had a favourable outcome with complete neurological recovery, despite a prolonged 65-day visual restitution delay. This unusual timeline may relate to two case-specific factors: the estimated two-week initial management delay and MRI haemorrhagic stigmata, whose association with more severe forms and prolonged recovery has been suggested. The absence of seizure recurrence and full visual recovery confirm PRES reversibility here, despite these severity markers. Limitations This observation has limitations, including lack of microbiological confirmation, its isolated nature, and difficulty pinpointing exact PRES onset. Abbreviations ADC : Apparent Diffusion Coefficient BBB : Blood-Brain Barrier DWI : Diffusion-Weighted Imaging FLAIR : Fluid-Attenuated Inversion Recovery ICU : Intensive Care Unit MRI : Magnetic Resonance Imaging PRES : Posterior Reversible Encephalopathy Syndrome SWAN : Susceptibility-Weighted Angiography Declarations Ethics approval and consent to participate This case report was conducted in accordance with the principles of the Declaration of Helsinki. Ethical approval for the publication of this case report was obtained from the Institutional Ethics Committee of the University Hospital Center of Treichville, Abidjan (Côte d'Ivoire) under the authority of the Hospital Direction, which serves as the institutional review body. Given the observational and non-interventional nature of this case report, formal written consent to participate was waived by the ethics committee. All patient data were anonymized and handled in strict accordance with patient confidentiality standards. Consent for publication Written informed consent for the publication of this case report and any accompanying images was obtained from the patient's parent(s) / legal guardian(s), as the patient was a minor at the time of manuscript preparation. Availability of data and materials All data supporting the findings of this case report are included within the published article. No additional datasets were generated or analyzed during the preparation of this manuscript. Competing interests The authors declare that they have no competing interests. Funding This case report received no specific funding from any public, commercial, or not-for-profit funding agency. Authors' contributions SSS : Conceptualization, Data curation, Writing – original draft, Writing – review & editing. KKLL : Data curation, Clinical management, Figures and tables design, Writing – review & editing. KKI : Data curation, Clinical management, Figures and tables design, Writing – review & editing. KKA : Data curation, Clinical management, Writing – review. ASCE : Investigation, Formal analysis, Figures and tables design, Writing – review & editing. BN : Supervision, Validation, Writing – review & editing. All authors read and approved the final manuscript. Acknowledgements Nothing References Geocadin RG. Posterior Reversible Encephalopathy Syndrome. Ropper AH, éditeur. N Engl J Med 8 juin. 2023;388(23):2171–8. 10.1056/NEJMra2114482 . Legriel S, Pico F, Bruneel F, Troché G, Bedos JP. Des pathologies encéphaliques à connaître — Syndrome d’encéphalopathie postérieure réversible. Réanimation 1 janv. 2011;20(2):368–78. 10.1007/s13546-010-0116-z . Saley T, Barton A, Sood SB, Thukaram R. Posterior Reversible Encephalopathy Syndrome Complicating Ruptured Appendicitis and Abscess Drainage in a Previously Healthy Pediatric Patient. J Pediatr Intensive Care juin. 2019;8(2):92–5. 10.1055/s-0038-1668603 . PubMed PMID: 31093461; PubMed Central PMCID: PMC6517167. Koller AMR, Man A, Muntean C. Posterior Reversible Encephalopathy Syndrome, not so Uncommon in Pediatric Patients with Renal Involvement: A Case Series. J Crit Care Med janv. 2024;10(1):96–102. 10.2478/jccm-2024-0004 . PubMed PMID: 39108796; PubMed Central PMCID: PMC11193964. Rafee Y, Allabwani R, Haddadin T, Kaddurah A. Posterior reversible encephalopathy syndrome following appendicitis in a young child: A case report and review of the pediatric literature. SAGE Open Med Case Rep. 2021;9:2050313X211053454. 10.1177/2050313X211053454 . PubMed PMID: 34691475; PubMed Central PMCID: PMC8529302. Siebert E, Bohner G, Endres M, Liman TG. Clinical and radiological spectrum of posterior reversible encephalopathy syndrome: does age make a difference?--A retrospective comparison between adult and pediatric patients. PLoS ONE. 2014;9(12):e115073. 10.1371/journal.pone.0115073 . PubMed PMID: 25514795; PubMed Central PMCID: PMC4267732. Elleuch A, Boudaya F, Ladhar M, Maalej B, Gargouri L, Mahfoudh EA. LA LEUCOENCEPHALOPATHIE POSTERIEURE REVERSIBLE (A PROPOS DE 4 CAS). Bartynski WS, Boardman JF, Zeigler ZR, Shadduck RK, Lister J. Posterior reversible encephalopathy syndrome in infection, sepsis, and shock. AJNR Am J Neuroradiol. 2006;27(10):2179–90. PubMed PMID: 17110690; PubMed Central PMCID: PMC7977225. Racchiusa S, Mormina E, Ax A, Musumeci O, Longo M, Granata F. Posterior reversible encephalopathy syndrome (PRES) and infection: a systematic review of the literature. Neurol Sci Off J Ital Neurol Soc Ital Soc Clin Neurophysiol mai. 2019;40(5):915–22. 10.1007/s10072-018-3651-4 . PubMed PMID: 30604335. Ndu IK, Ayuk AC, Onukwuli VO. Challenges of Diagnosing Pediatric Posterior Reversible Encephalopathy Syndrome in Resource Poor Settings: A Narrative Review. Glob Pediatr Health 1 janv. 2020;7:2333794X20947924. 10.1177/2333794X20947924 . Rheims S, Gobert F, Andre-Obadia N, Dailler F. État de mal épileptique chez l’adulte : diagnostic et traitement. Prat Neurol - FMC mai. 2021;12(2):103–8. 10.1016/j.praneu.2021.03.012 . Whelton PK, Carey RM, Aronow WS, Casey DE, Collins KJ, Dennison Himmelfarb C et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Hypertension. juin 2018;71(6):e13–115. 10.1161/HYP.0000000000000065 PubMed PMID: 29133356. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Reviewers agreed at journal 06 May, 2026 Reviews received at journal 30 Apr, 2026 Reviewers agreed at journal 23 Apr, 2026 Reviewers invited by journal 21 Apr, 2026 Editor assigned by journal 21 Apr, 2026 Editor invited by journal 20 Apr, 2026 Submission checks completed at journal 17 Apr, 2026 First submitted to journal 17 Apr, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9349548","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Case Report","associatedPublications":[],"authors":[{"id":629838954,"identity":"e1226c0a-4872-4d7d-904f-5c48db3e53a3","order_by":0,"name":"Servais Sontia SAI","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAx0lEQVRIiWNgGAWjYLCCBIb/cgwMPCCmHFEaGBsSGJiNoVqMidTCwMCc2EC0Fvn23uMPHtSwpW84fvbggw8MBvkEtRicOZfYkHCMJ3fDmbxkwxkMBpYNBLVI5Bg2JLBJ5G44kGMmzcPwx4Cww2aAtPwzSDc4/wakxYCwFoYbQC2JbQkJBjdyiNRicOaM4YzEvgOGM2+8MTacYUCEFvn2HoOPP74dkOc7n2P44EMFMQ6DAYUDYEuJ1wC0roEU1aNgFIyCUTCiAABwlzxA43EulgAAAABJRU5ErkJggg==","orcid":"","institution":"Université Félix Houphouët-Boigny","correspondingAuthor":true,"prefix":"","firstName":"Servais","middleName":"Sontia","lastName":"SAI","suffix":""},{"id":629838955,"identity":"f3bd5f51-be0b-4fcd-a0ea-0d8716ccc51a","order_by":1,"name":"Koffi Isidore KOUAME","email":"","orcid":"","institution":"Université Félix Houphouët-Boigny","correspondingAuthor":false,"prefix":"","firstName":"Koffi","middleName":"Isidore","lastName":"KOUAME","suffix":""},{"id":629838957,"identity":"41cd78f9-0329-4674-b7e3-bf752e4d2356","order_by":2,"name":"Kouadio Antoine KOUAME","email":"","orcid":"","institution":"Université Félix Houphouët-Boigny","correspondingAuthor":false,"prefix":"","firstName":"Kouadio","middleName":"Antoine","lastName":"KOUAME","suffix":""},{"id":629838962,"identity":"3d92f9eb-ec3f-488a-bf61-94b92228d51b","order_by":3,"name":"Stephane Charles-Evrard ADINGRA","email":"","orcid":"","institution":"Université Félix Houphouët-Boigny","correspondingAuthor":false,"prefix":"","firstName":"Stephane","middleName":"Charles-Evrard","lastName":"ADINGRA","suffix":""},{"id":629838964,"identity":"e7dae685-01f5-4091-8815-5253fb03fdc0","order_by":4,"name":"Narcisse BOUA","email":"","orcid":"","institution":"Université Félix Houphouët-Boigny","correspondingAuthor":false,"prefix":"","firstName":"Narcisse","middleName":"","lastName":"BOUA","suffix":""},{"id":629838966,"identity":"d18a197d-4583-43f8-9d02-be9ecbcff756","order_by":5,"name":"Lebailly Landry KOHOU-KONE","email":"","orcid":"","institution":"Université Félix Houphouët-Boigny","correspondingAuthor":false,"prefix":"","firstName":"Lebailly","middleName":"Landry","lastName":"KOHOU-KONE","suffix":""}],"badges":[],"createdAt":"2026-04-07 22:09:12","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9349548/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9349548/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":108398270,"identity":"875ca5cc-a954-46b7-be76-39cda62f4307","added_by":"auto","created_at":"2026-05-04 08:28:53","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":613994,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003ea.\u003c/strong\u003eDiffusion-weighted imaging (DWI) demonstrating vasogenic edema as hyperintense signal (yellow arrows) without restricted diffusion on the ADC map.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e1b.\u003c/strong\u003e T2/FLAIR sequence showing occipital hyperintense signal (green arrows).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e1c.\u003c/strong\u003e SWAN sequence revealing hypointense signal (blue arrows) localized to the bilateral occipital and cerebellar regions.\u003c/p\u003e","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-9349548/v1/847301e9006a06ca72d8e227.jpeg"},{"id":108976618,"identity":"cc5dec4e-509d-4a82-9014-1032ada8eeaf","added_by":"auto","created_at":"2026-05-11 11:26:18","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":882057,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9349548/v1/79db6e5f-0be1-46e0-8910-bae02c8f905d.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003ePosterior Reversible Encephalopathy Syndrome (Pres) Following Peritonitis in a Child\u003c/p\u003e","fulltext":[{"header":"KEY POINTS","content":"\u003col\u003e\u003cli\u003ePRES should be considered in any acute neurological picture following sepsis, including in paediatrics.\u003c/li\u003e\n \u003cli\u003eInflammatory endothelial dysfunction can induce PRES without hypertension; its absence alone does not rule out the diagnosis.\u003c/li\u003e\n \u003cli\u003eEarly and optimal management of underlying sepsis remains the cornerstone of therapy. Any treatment delay may promote more severe forms and prolonged recovery.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"INTRODUCTION","content":"\u003cp\u003ePosterior Reversible Encephalopathy Syndrome (PRES) is a neurological entity with diverse clinical manifestations [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. In the absence of specific clinical signs, diagnosis relies primarily on brain Magnetic Resonance Imaging (MRI), which reveals vasogenic oedema predominantly in the white matter of the occipital lobes and sometimes the parietal lobes [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Although initially described in adults, PRES can also occur in the paediatric population.[\u003cspan additionalcitationids=\"CR4 CR5 CR6\" citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eThe at-risk populations for this radio-clinical syndrome are well established [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. More recently, sepsis has been identified as an independent risk factor, with a few cases reported in the literature [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. While paediatric PRES cases associated with sepsis have been described, those occurring in the context of sepsis of digestive origin remain rare [\u003cspan additionalcitationids=\"CR4\" citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. In sub-Saharan Africa, and particularly in C\u0026ocirc;te d'Ivoire, this entity does not appear to have been documented in paediatric intensive care settings, likely due to diagnostic constraints [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eWe report here a case of PRES revealed by seizures and blindness in an adolescent girl admitted for acute peritonitis that was managed late.\u003c/p\u003e"},{"header":"CASE PRESENTATION","content":"\u003cp\u003eA 12-year-old adolescent girl with no significant medical history, residing in a rural area, was admitted to the paediatric emergency department for abdominal pain syndrome associated with unmeasured prehospital fever and altered general condition, evolving for approximately two weeks. The diagnosis was peritonitis with signs of dehydration. While awaiting surgery, the patient experienced two seizures treated with two 5 mg doses of midazolam, prompting her admission to the Intensive Care Unit (ICU).\u003c/p\u003e \u003cp\u003eOn admission, clinical examination revealed arterial hypertension (160/90 mmHg), tachycardia (92 bpm), and mild jaundice. There was altered consciousness (Glasgow Coma Scale score of 10 \u0026mdash; E2V2M6 \u0026mdash;) with intermittent agitation and choreiform movements. No sensorimotor deficits or meningeal signs were noted. Respiratory status was stable (SpO₂: 96% on room air). Laboratory investigations showed severe hypoglycaemia (0.3 g/L), renal dysfunction, signs of hepatocellular insufficiency, and severe metabolic acidosis (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Initial management included emergency glucose administration, rehydration, broad-spectrum antibiotics (piperacillin-tazobactam and amikacin), blood transfusion, and vitamin K1 supplementation. Exploratory laparotomy, performed approximately six hours after ICU admission, revealed a single ileal perforation without mesenteric adenolymphitis. A segmental ileal resection with diverting stoma was carried out.\u003c/p\u003e \u003cp\u003eIn the immediate postoperative period, the patient remained agitated with persistent choreiform movements and intermittent bruxism. These neurological disturbances, combined with renal dysfunction and oedema, raised suspicion of uraemic encephalopathy. Two haemodialysis sessions were performed, improving consciousness (Glasgow 15) and renal function (see Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e), but with no notable effect on agitation or hypertension (systolic blood pressure 140\u0026ndash;160 mmHg).\u003c/p\u003e \u003cp\u003eOn postoperative day 10, the course was marked by refractory seizures unresponsive to midazolam and the onset of bilateral blindness. Seizures were controlled with the addition of levetiracetam. Brain MRI showed hyperintensity in the cortical white matter without restricted apparent diffusion coefficient (ADC), consistent with vasogenic oedema. Lesions were diffuse, bilateral, symmetrical, predominantly parieto-occipital with associated cerebellar involvement. They showed no enhancement after gadolinium administration. Rare hypointense foci on susceptibility-weighted sequences indicated haemorrhagic stigmata (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). PRES was diagnosed, and intravenous nicardipine was initiated for blood pressure control, targeting systolic blood pressure below 140 mmHg. The patient stayed 17 days in the ICU before transfer to paediatric surgery, where gastrointestinal continuity was later restored. The outcome was favourable, with no seizure recurrence. Full visual recovery occurred after approximately 65 days.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSummary of the kinetics of biological parameters during the clinical course of our patient\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParameters (units)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAdmission\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eD2\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eD10 (Post-RRT)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eD20 in ICU\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNormal values\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWBC (cells/mm\u0026sup3;)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e24,800\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e30,400\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e17,800\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e9,910\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e[4,000\u0026ndash;10,000]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHb (g/dL)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e10.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHct (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e36.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e26.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e34.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e[36\u0026ndash;46]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePlatelets (cells/mm\u0026sup3;)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e121,000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e180,000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e367,000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e257,000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e[150,000\u0026ndash;400,000]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNatremia (mEq/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e130\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e129\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e136\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e143\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e[135\u0026ndash;145]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKalemia (mEq/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3.57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e[3.5\u0026ndash;5.0]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChloremia (mEq/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e105\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e[95\u0026ndash;105]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCalcemia (mg/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e[88\u0026ndash;104]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMagnesemia (mg/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e[17\u0026ndash;24]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCRP (mg/mL)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e234\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePCT (ng/mL)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e65.88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eASAT (IU/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e108\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;40\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eALAT (IU/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;40\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUrea (g/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e[0.15\u0026ndash;0.45]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCreatinine (mg/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e[7\u0026ndash;13]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003epH\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7.12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7.34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7.40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e[7.38\u0026ndash;7.42]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePaO₂ (mmHg)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e101\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e102\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e[80\u0026ndash;100]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePaCO₂ (mmHg)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e27.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e[35\u0026ndash;45]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHCO₃ (mmol/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e[22\u0026ndash;26]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLactate (mmol/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026le;\u0026thinsp;2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e\u003cp\u003eAbbreviations: RRT: Renal Replacement Therapy \u0026mdash; Hb: Hemoglobin \u0026mdash; Hct: Hematocrit \u0026mdash; CRP: C-Reactive Protein \u0026mdash; PCT: Procalcitonin \u0026mdash; WBC: White Blood Cells \u0026mdash; D: Day \u0026mdash; ICU: Intensive Care Unit\u003c/p\u003e\n\u003cp\u003eTable 2: Comparative bioclinical and outcome characteristics of pediatric PRES cases secondary to sepsis of gastrointestinal origin\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"3\" cellpadding=\"0\" width=\"655\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003eParameters\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 159px;\"\u003e\n \u003cp\u003eOur case\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 149px;\"\u003e\n \u003cp\u003eSaley\u0026nbsp;[3]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 186px;\"\u003e\n \u003cp\u003eRafee\u0026nbsp;[5]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 159px;\"\u003e\n \u003cp\u003e12 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 149px;\"\u003e\n \u003cp\u003e5 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 186px;\"\u003e\n \u003cp\u003e11 years\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003eSex\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 159px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 149px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 186px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003eMedical history\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 159px;\"\u003e\n \u003cp\u003eNone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 149px;\"\u003e\n \u003cp\u003eNone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 186px;\"\u003e\n \u003cp\u003eNone\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003eGastrointestinal lesion\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 159px;\"\u003e\n \u003cp\u003eIleal perforation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 149px;\"\u003e\n \u003cp\u003ePerforated appendicitis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 186px;\"\u003e\n \u003cp\u003ePerforated appendicitis\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003eIdentified organisms\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 159px;\"\u003e\n \u003cp\u003eNot specified\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 149px;\"\u003e\n \u003cp\u003e\u003cem\u003eE. coli\u003c/em\u003e, \u003cem\u003eB. fragilis\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 186px;\"\u003e\n \u003cp\u003e\u003cem\u003eE. coli\u003c/em\u003e, \u003cem\u003eP. aeruginosa\u003c/em\u003e,\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eS. constellatus\u003c/em\u003e, \u003cem\u003eBacteroides\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003eDelay before admission\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 159px;\"\u003e\n \u003cp\u003e\u0026asymp; 2 weeks\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 149px;\"\u003e\n \u003cp\u003ePrompt\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 186px;\"\u003e\n \u003cp\u003e7 days\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003eHypertension at admission\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 159px;\"\u003e\n \u003cp\u003eGrade 2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 149px;\"\u003e\n \u003cp\u003eGrade 2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 186px;\"\u003e\n \u003cp\u003eGrade 2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003eOrgan dysfunction\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 159px;\"\u003e\n \u003cp\u003eAcute kidney injury\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 149px;\"\u003e\n \u003cp\u003ePulmonary edema\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 186px;\"\u003e\n \u003cp\u003eNone\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003eSeizures\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 159px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 149px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 186px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003eVisual disturbances\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 159px;\"\u003e\n \u003cp\u003eYes (Cortical blindness)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 149px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 186px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003eHemorrhage on MRI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 159px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 149px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 186px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003eAntiepileptic treatment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 159px;\"\u003e\n \u003cp\u003eBenzodiazepine, Levetiracetam\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 149px;\"\u003e\n \u003cp\u003eBenzodiazepine, Fosphenytoin\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 186px;\"\u003e\n \u003cp\u003eLorazepam\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003eAntihypertensive treatment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 159px;\"\u003e\n \u003cp\u003eIV Nicardipine\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 149px;\"\u003e\n \u003cp\u003eNone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 186px;\"\u003e\n \u003cp\u003eOral Isradipine\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003eTime to recovery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 159px;\"\u003e\n \u003cp\u003e65 days\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 149px;\"\u003e\n \u003cp\u003e25 days\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 186px;\"\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eWe report a case of posterior reversible encephalopathy syndrome (PRES) in an adolescent following acute peritonitis due to ileal perforation, revealed by status epilepticus associated with transient cortical blindness. To our knowledge, this is one of the few paediatric cases of PRES secondary to sepsis of digestive origin reported in sub-Saharan Africa. The rarity of this association warrants comparison with the literature and discussion of the underlying pathophysiological mechanisms.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePathophysiology\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe pathophysiology of PRES, though not fully elucidated, involves two main mechanisms [1\u0026ndash;8]. The most commonly described involves severe arterial hypertension exceeding cerebral autoregulation capacity, leading to cerebral hyperperfusion and endothelial dysfunction with blood-brain barrier (BBB) disruption. This promotes vasogenic oedema formation. The second mechanism, implicated in sepsis, involves inflammatory endothelial dysfunction. Here, proinflammatory mediators\u0026mdash;particularly immunomodulatory and cytotoxic agents\u0026mdash;directly impair the BBB independently of hypertension. This is observed in PRES cases without hypertensive context. Thus, regardless of the underlying aetiology, endothelial dysfunction and subsequent BBB alteration appear as the common denominator leading to cerebral vasogenic oedema. Both mechanisms appear intertwined in our patient.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMicrobiology\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe lack of microbiological documentation of peritoneal fluid is a notable limitation of our observation. Nevertheless, given the high prevalence of \u003cem\u003eSalmonella typhi\u003c/em\u003e as the aetiological agent of ileal perforations in our setting, a typhoid origin remains the most likely hypothesis, though it cannot be formally confirmed.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eOnset Timing\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn our patient, the initial preoperative seizures in the context of severe hypoglycaemia cannot be attributed to PRES, complicating precise determination of symptom onset. However, considering postoperative day 5\u0026mdash;marked by refractory seizures with bilateral blindness\u0026mdash;as the clinical revelation point, our case stands out by its earlier onset [5\u0026ndash;12]. This may be explained by the estimated two-week delay in initial management.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical Features\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePaediatric PRES most often occurs in children without prior history, in a sepsis context, with neurological manifestations dominated by seizures. These are the primary mode of revelation and frequently progress to status epilepticus, especially in younger patients [13]. Consciousness may remain preserved, as in our case. The onset of bilateral cortical blindness was the most striking feature here. Reported in 20\u0026ndash;39% of PRES cases [1], it remains rare in paediatrics and, in our patient, resulted from bilateral occipital cortical vasogenic oedema on MRI, without anterior optic pathway involvement. Concomitant acute kidney injury initially suggested uraemic encephalopathy. Its dismissal after two haemodialysis sessions without neurological improvement underscores the need to consider PRES in the differential diagnosis of any unexplained acute neurological picture in sepsis, even with potentially explanatory organ failure.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTherapeutic Aspects\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eManagement of our patient focused on seizure control, blood pressure management, and treatment of underlying sepsis. Antiepileptic therapy followed standard status epilepticus protocols [11]. First-line benzodiazepine (midazolam) was followed by a long-acting antiepileptic (levetiracetam), selected for its favourable profile: cardiorespiratory safety and lack of significant sedation, ideal for neurological monitoring in ICU. Intravenous nicardipine was chosen as the antihypertensive due to its availability, targeting progressive systolic blood pressure reduction [12]. However, its positive chronotropic effect is a limitation in some haemodynamic contexts, where labetalol may be a better alternative if available. Notably, antihypertensives were not required in some septic PRES cases [3], highlighting the need to tailor blood pressure strategy to the individual patient profile.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eOutcome\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOur patient had a favourable outcome with complete neurological recovery, despite a prolonged 65-day visual restitution delay. This unusual timeline may relate to two case-specific factors: the estimated two-week initial management delay and MRI haemorrhagic stigmata, whose association with more severe forms and prolonged recovery has been suggested. The absence of seizure recurrence and full visual recovery confirm PRES reversibility here, despite these severity markers.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLimitations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis observation has limitations, including lack of microbiological confirmation, its isolated nature, and difficulty pinpointing exact PRES onset.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eADC\u0026nbsp;: Apparent Diffusion Coefficient\u003c/p\u003e\n\u003cp\u003eBBB : Blood-Brain Barrier\u003c/p\u003e\n\u003cp\u003eDWI : Diffusion-Weighted Imaging\u003c/p\u003e\n\u003cp\u003eFLAIR : Fluid-Attenuated Inversion Recovery\u003c/p\u003e\n\u003cp\u003eICU : Intensive Care Unit\u003c/p\u003e\n\u003cp\u003eMRI : Magnetic Resonance Imaging\u003c/p\u003e\n\u003cp\u003ePRES : Posterior Reversible Encephalopathy Syndrome\u003c/p\u003e\n\u003cp\u003eSWAN : Susceptibility-Weighted Angiography\u003c/p\u003e"},{"header":"Declarations","content":"\u003cul type=\"disc\"\u003e\n \u003cli\u003eEthics approval and consent to participate\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eThis case report was conducted in accordance with the principles of the Declaration of Helsinki. Ethical approval for the publication of this case report was obtained from the Institutional Ethics Committee of the University Hospital Center of Treichville, Abidjan (C\u0026ocirc;te d\u0026apos;Ivoire) under the authority of the Hospital Direction, which serves as the institutional review body. Given the observational and non-interventional nature of this case report, formal written consent to participate was waived by the ethics committee. All patient data were anonymized and handled in strict accordance with patient confidentiality standards.\u003c/p\u003e\n\u003cul type=\"disc\"\u003e\n \u003cli\u003eConsent for publication\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eWritten informed consent for the publication of this case report and any accompanying images was obtained from the patient\u0026apos;s parent(s) / legal guardian(s), as the patient was a minor at the time of manuscript preparation.\u003c/p\u003e\n\u003cul type=\"disc\"\u003e\n \u003cli\u003eAvailability of data and materials\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eAll data supporting the findings of this case report are included within the published article. No additional datasets were generated or analyzed during the preparation of this manuscript.\u003c/p\u003e\n\u003cul type=\"disc\"\u003e\n \u003cli\u003eCompeting interests\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cul type=\"disc\"\u003e\n \u003cli\u003eFunding\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eThis case report received no specific funding from any public, commercial, or not-for-profit funding agency.\u003c/p\u003e\n\u003cul type=\"disc\"\u003e\n \u003cli\u003eAuthors\u0026apos; contributions\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eSSS : Conceptualization, Data curation, Writing \u0026ndash; original draft, Writing \u0026ndash; review \u0026amp; editing.\u003c/p\u003e\n\u003cp\u003eKKLL : Data curation, Clinical management, Figures and tables design, Writing \u0026ndash; review \u0026amp; editing.\u003c/p\u003e\n\u003cp\u003eKKI : Data curation, Clinical management, Figures and tables design, Writing \u0026ndash; review \u0026amp; editing.\u003c/p\u003e\n\u003cp\u003eKKA : Data curation, Clinical management, Writing \u0026ndash; review.\u003c/p\u003e\n\u003cp\u003eASCE : Investigation, Formal analysis, Figures and tables design, Writing \u0026ndash; review \u0026amp; editing.\u003c/p\u003e\n\u003cp\u003eBN : Supervision, Validation, Writing \u0026ndash; review \u0026amp; editing.\u003c/p\u003e\n\u003cp\u003eAll authors read and approved the final manuscript.\u003c/p\u003e\n\u003cul type=\"disc\"\u003e\n \u003cli\u003eAcknowledgements\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eNothing\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eGeocadin RG. 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Hypertension. juin 2018;71(6):e13\u0026ndash;115. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1161/HYP.0000000000000065\u003c/span\u003e\u003cspan address=\"10.1161/HYP.0000000000000065\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e PubMed PMID: 29133356.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-anesthesiology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bane","sideBox":"Learn more about [BMC Anesthesiology](http://bmcanesthesiol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bane","title":"BMC Anesthesiology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-9349548/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9349548/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"The variability of clinical presentations and the absence of an obvious etiology may delay the diagnosis of Posterior Reversible Encephalopathy Syndrome (PRES) in pediatric patients, particularly in resource-limited settings. We report the case of a 12-year-old girl admitted to the intensive care unit for peritonitis secondary to ileal perforation, whose postoperative course was complicated by refractory convulsive status epilepticus associated with bilateral cortical blindness. The diagnosis of PRES was confirmed by brain MRI, which demonstrated bilateral parieto-occipital vasogenic edema with hemorrhagic stigmata. Despite a prolonged visual recovery (65 days), the overall outcome was favorable. This case highlights that PRES should be considered in any acute neurological presentation occurring in a septic context — including in the absence of hypertension — and that early diagnosis and etiological management are key determinants of neurological outcome.","manuscriptTitle":"Posterior Reversible Encephalopathy Syndrome (Pres) Following Peritonitis in a Child","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-05-04 08:28:49","doi":"10.21203/rs.3.rs-9349548/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewerAgreed","content":"310937670022923102693891665093950001310","date":"2026-05-06T13:02:48+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-30T16:36:58+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"89094321511269049471359069241193186188","date":"2026-04-23T16:17:19+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-04-21T19:06:46+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-04-21T19:04:57+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-04-20T13:30:48+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-04-17T21:37:41+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Anesthesiology","date":"2026-04-17T21:06:51+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-anesthesiology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bane","sideBox":"Learn more about [BMC Anesthesiology](http://bmcanesthesiol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bane","title":"BMC Anesthesiology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"3cc4a9d8-11d9-4a56-888c-28a1acae0eb1","owner":[],"postedDate":"May 4th, 2026","published":true,"recentEditorialEvents":[{"type":"reviewerAgreed","content":"310937670022923102693891665093950001310","date":"2026-05-06T13:02:48+00:00","index":33,"fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-30T16:36:58+00:00","index":27,"fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-05-04T08:28:50+00:00","versionOfRecord":[],"versionCreatedAt":"2026-05-04 08:28:49","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9349548","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9349548","identity":"rs-9349548","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}