This toddler presented with an unprovoked seizure and was found on CT to have a small acute subdural hemorrhage. The child developed intermittent elevated blood pressure on hospital day 2 and 3, and was found to have PRES on head MR on day 4.

PRES in children has been reported in association with hematologic and immunologic conditions as well as systemic inflammatory conditions. It is also associated with dramatic increases in blood pressure. In this case, the sequence of events was trauma, then seizure, then elevated blood pressure, then PRES.

PRES has been reported in children as young as 2 years. PRES in an 18-month-old toddler is very unusual.

DIFFERENTIAL DIAGNOSIS

-Neonatal hypoglycemia can cause increased FLAIR signal bilaterally in the parieto occipital regions, the pulvinar nucleus is often involved

-Status epilepticus can cause a similar picture but the corpus callosum will demonstrate restricted diffusion.