Ictal-interictal spectrum: an EEG warning sign of hypertensive encephalopathy.

Abstract

Objective: Hypertensive encephalopathy may complicate the course of pediatric nephrotic syndrome, and the resulting brain injury is not always reversible. Subclinical electroencephalographic activities may play a role in this context, as demonstrated by the case vignette.

Method: We report on a girl with IgA nephropathy and secondary hypertension, leading to posterior reversible encephalopathy syndrome (PRES). The correlated neuroimaging and electroencephalographic findings are examined, and their clinical implications are discussed.

Results: PRES could be associated with lateralized periodic discharges on electroencephalogram, which was topographically concordant with neuroimaging findings in this patient. Despite being clinically silent, the lateralized periodic discharges may potentially increase cerebral metabolic demand and adversely impact the neurological outcomes.

Conclusion: Electroencephalographic monitoring should be considered in the context of PRES, as it may help detect subclinical electrical activities in the brain, which is of potential therapeutic relevance.