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Not for further distribution unless allowed by the License or with the express written permission of Cambridge University Press.
https://doi.org/10.1017/S0317167100006740
https://doi.org/10.1017/S0317167100006740 Published online by Cambridge University Press
2022-04-12T19:44:35+00:00
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(Can. J. Neurol. Sci. 2007; 34: 316-321)Tj
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[(From the Division of Pediatric Neurology \(ECW)92(, LDH\), Departments of Pediatrics)]TJ
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/F9 1 Tf
8.4 0 0 8.4 199.13 535.3641 Tm
[(0.)-10(13)]TJ
ET
Q
q
255.41 173.8282 62.664 554.4 re
W n
BT
/F9 1 Tf
8.4 0 0 8.4 258.938 535.3641 Tm
[(0.)-10(79)]TJ
ET
Q
q
318.41 173.8282 78.456 554.4 re
W n
BT
/F9 1 Tf
8.4 0 0 8.4 321.938 535.3641 Tm
[(3.)-10(80)]TJ
ET
Q
q
397.202 173.8282 78.288 554.4 re
W n
BT
/F9 1 Tf
8.4 0 0 8.4 400.73 535.3641 Tm
[(1.)-10(12)]TJ
ET
Q
122.354 543.0921 72.912 0.336 re
f
195.266 543.0921 0.336 0.336 re
f
195.602 543.0921 59.472 0.336 re
f
255.074 543.0921 0.336 0.336 re
f
255.41 543.0921 62.664 0.336 re
f
318.074 543.0921 0.336 0.336 re
f
318.41 543.0921 78.456 0.336 re
f
396.866 543.0921 0.336 0.336 re
f
397.202 543.0921 78.288 0.336 re
f
195.266 523.7722 0.336 19.32 re
f
255.074 523.7722 0.336 19.32 re
f
318.074 523.7722 0.336 19.32 re
f
396.866 523.7722 0.336 19.32 re
f
q
122.354 173.8282 72.912 554.4 re
W n
BT
/F8 1 Tf
8.4 0 0 8.4 126.05 515.7081 Tm
0.002 Tc
[(U)4(r)6(in)-2(a)2(ly)2(s)11(is)]TJ
ET
Q
q
195.602 173.8282 59.472 554.4 re
W n
BT
/F9 1 Tf
8.4 0 0 8.4 199.13 515.7081 Tm
-0.007 Tc
0.017 Tw
[(>)-3(3)-7(0)-7( RBC/)-9(H)-5(P)-11(F)]TJ
ET
Q
q
195.602 173.8282 59.472 554.4 re
W n
BT
/F9 1 Tf
8.4 0 0 8.4 199.13 506.1321 Tm
(5)Tj
ET
Q
q
195.602 173.8282 59.472 554.4 re
W n
BT
/F9 1 Tf
8.4 0 0 8.4 203.33 506.1321 Tm
(-)Tj
ET
Q
q
195.602 173.8282 59.472 554.4 re
W n
BT
/F9 1 Tf
8.4 0 0 8.4 206.186 506.1321 Tm
0.01 Tw
[(10 hya)4(l)-2(i)-2(ne)]TJ
ET
Q
q
195.602 173.8282 59.472 554.4 re
W n
BT
/F9 1 Tf
8.4 0 0 8.4 199.13 496.3881 Tm
-0.004 Tc
[(cas)5(t)-6(s)5(/)-6(L)-13(P)-8(F)]TJ
ET
Q
q
255.41 173.8282 62.664 554.4 re
W n
BT
/F9 1 Tf
8.4 0 0 8.4 258.938 515.7081 Tm
-0.007 Tc
0.017 Tw
[(>)-3(3)-7(0)-7( RBC/)-9(H)-5(P)-11(F)]TJ
ET
Q
q
255.41 173.8282 62.664 554.4 re
W n
BT
/F9 1 Tf
8.4 0 0 8.4 258.938 506.1321 Tm
(10)Tj
ET
Q
q
255.41 173.8282 62.664 554.4 re
W n
BT
/F9 1 Tf
8.4 0 0 8.4 267.338 506.1321 Tm
(-)Tj
ET
Q
q
255.41 173.8282 62.664 554.4 re
W n
BT
/F9 1 Tf
8.4 0 0 8.4 270.194 506.1321 Tm
(20)Tj
1.26 0 Td
[(hya)4(l)-2(i)-2(ne)]TJ
ET
Q
q
255.41 173.8282 62.664 554.4 re
W n
BT
/F9 1 Tf
8.4 0 0 8.4 258.938 496.3881 Tm
-0.004 Tc
[(cas)5(t)-6(s)5(/)-6(L)-14(P)-7(F)]TJ
ET
Q
q
318.41 173.8282 78.456 554.4 re
W n
BT
/F9 1 Tf
8.4 0 0 8.4 321.938 515.7081 Tm
(5)Tj
ET
Q
q
318.41 173.8282 78.456 554.4 re
W n
BT
/F9 1 Tf
8.4 0 0 8.4 326.138 515.7081 Tm
(-)Tj
ET
Q
q
318.41 173.8282 78.456 554.4 re
W n
BT
/F9 1 Tf
8.4 0 0 8.4 328.994 515.7081 Tm
(10)Tj
1.26 0 Td
-0.007 Tc
[(W)-3(BC/)-9(H)-5(P)-11(F)]TJ
ET
Q
q
318.41 173.8282 78.456 554.4 re
W n
BT
/F9 1 Tf
8.4 0 0 8.4 321.938 506.1321 Tm
(5)Tj
ET
Q
q
318.41 173.8282 78.456 554.4 re
W n
BT
/F9 1 Tf
8.4 0 0 8.4 326.138 506.1321 Tm
(-)Tj
ET
Q
q
318.41 173.8282 78.456 554.4 re
W n
BT
/F9 1 Tf
8.4 0 0 8.4 328.994 506.1321 Tm
(10)Tj
1.26 0 Td
-0.007 Tc
[(RBC/)-9(H)-5(P)-11(F)]TJ
ET
Q
q
318.41 173.8282 78.456 554.4 re
W n
BT
/F9 1 Tf
8.4 0 0 8.4 321.938 496.3881 Tm
(10)Tj
ET
Q
q
318.41 173.8282 78.456 554.4 re
W n
BT
/F9 1 Tf
8.4 0 0 8.4 330.338 496.3881 Tm
(-)Tj
ET
Q
q
318.41 173.8282 78.456 554.4 re
W n
BT
/F9 1 Tf
8.4 0 0 8.4 333.194 496.3881 Tm
(20)Tj
1.26 0 Td
[(gr)-7(a)4(nul)-2(a)3(r)]TJ
ET
Q
q
318.41 173.8282 78.456 554.4 re
W n
BT
/F9 1 Tf
8.4 0 0 8.4 321.938 486.8122 Tm
-0.004 Tc
[(cas)5(t)-6(s)5(/)-6(L)-14(P)-7(F)]TJ
ET
Q
q
397.202 173.8282 78.288 554.4 re
W n
BT
/F9 1 Tf
8.4 0 0 8.4 400.73 515.7081 Tm
(5)Tj
ET
Q
q
397.202 173.8282 78.288 554.4 re
W n
BT
/F9 1 Tf
8.4 0 0 8.4 404.93 515.7081 Tm
(-)Tj
ET
Q
q
397.202 173.8282 78.288 554.4 re
W n
BT
/F9 1 Tf
8.4 0 0 8.4 407.786 515.7081 Tm
(10)Tj
1.26 0 Td
-0.007 Tc
[(W)-3(BC/)-9(H)-5(P)-11(F)]TJ
ET
Q
q
397.202 173.8282 78.288 554.4 re
W n
BT
/F9 1 Tf
8.4 0 0 8.4 400.73 506.1321 Tm
-0.007 Tc
0.017 Tw
[(>)-3(3)-7(0)-7( RBC/)-9(H)-5(P)-11(F)]TJ
ET
Q
122.354 523.4362 72.912 0.336 re
f
195.266 523.4362 0.336 0.336 re
f
195.602 523.4362 59.472 0.336 re
f
255.074 523.4362 0.336 0.336 re
f
255.41 523.4362 62.664 0.336 re
f
318.074 523.4362 0.336 0.336 re
f
318.41 523.4362 78.456 0.336 re
f
396.866 523.4362 0.336 0.336 re
f
397.202 523.4362 78.288 0.336 re
f
195.266 484.7961 0.336 38.64 re
f
255.074 484.7961 0.336 38.64 re
f
318.074 484.7961 0.336 38.64 re
f
396.866 484.7961 0.336 38.64 re
f
q
122.354 173.8282 72.912 554.4 re
W n
BT
/F8 1 Tf
8.4 0 0 8.4 126.05 476.7321 Tm
-0.002 Tc
(C3)Tj
ET
Q
q
122.354 173.8282 72.912 554.4 re
W n
BT
/F9 1 Tf
8.4 0 0 8.4 138.482 476.7321 Tm
0.007 Tc
[(\(g)7(/)5(l)]TJ
ET
Q
q
122.354 173.8282 72.912 554.4 re
W n
BT
/F9 1 Tf
8.4 0 0 8.4 150.242 476.7321 Tm
(\))Tj
ET
Q
q
195.602 173.8282 59.472 554.4 re
W n
BT
/F9 1 Tf
8.4 0 0 8.4 199.13 476.7321 Tm
0.01 Tw
[(<)4(0.)-10(15 \()-7(l)-2(ow)22(\))]TJ
ET
Q
q
195.602 173.8282 59.472 554.4 re
W n
BT
/F9 1 Tf
8.4 0 0 8.4 199.13 466.9881 Tm
-0.004 Tc
[(R)3(ep)-4(eat)-267(at)-266(2)-4( )]TJ
ET
Q
q
195.602 173.8282 59.472 554.4 re
W n
BT
/F9 1 Tf
8.4 0 0 8.4 199.13 457.4122 Tm
0.002 Tc
[(mo)2(s)]TJ
ET
Q
q
195.602 173.8282 59.472 554.4 re
W n
BT
/F9 1 Tf
8.4 0 0 8.4 215.258 457.4122 Tm
Tj
ET
Q
q
195.602 173.8282 59.472 554.4 re
W n
BT
/F9 1 Tf
8.4 0 0 8.4 221.642 457.4122 Tm
[(1.)-10(08)]TJ
ET
Q
q
255.41 173.8282 62.664 554.4 re
W n
BT
/F9 1 Tf
8.4 0 0 8.4 258.938 476.7321 Tm
0.01 Tw
[(0.)-10(16 \()-7(l)-2(ow)22(\))]TJ
ET
Q
q
255.41 173.8282 62.664 554.4 re
W n
BT
/F9 1 Tf
8.4 0 0 8.4 258.938 466.9881 Tm
-0.004 Tc
[(R)3(ep)-4(eat)-267(at)-266(3)-4( )]TJ
ET
Q
q
255.41 173.8282 62.664 554.4 re
W n
BT
/F9 1 Tf
8.4 0 0 8.4 258.938 457.4122 Tm
-0.004 Tc
[(w)-2(eek)-4(s)]TJ
ET
Q
q
255.41 173.8282 62.664 554.4 re
W n
BT
/F9 1 Tf
8.4 0 0 8.4 281.954 457.4122 Tm
Tj
ET
Q
q
255.41 173.8282 62.664 554.4 re
W n
BT
/F9 1 Tf
8.4 0 0 8.4 288.338 457.4122 Tm
[(0.)-10(88)]TJ
ET
Q
q
318.41 173.8282 78.456 554.4 re
W n
BT
/F9 1 Tf
8.4 0 0 8.4 321.938 476.7321 Tm
[(1.)-10(22)]TJ
ET
Q
q
397.202 173.8282 78.288 554.4 re
W n
BT
/F9 1 Tf
8.4 0 0 8.4 400.73 476.7321 Tm
0.01 Tw
[(0.)-10(15 \()-7(l)-2(ow)22(\))]TJ
ET
Q
122.354 484.4601 72.912 0.336 re
f
195.266 484.4601 0.336 0.336 re
f
195.602 484.4601 59.472 0.336 re
f
255.074 484.4601 0.336 0.336 re
f
255.41 484.4601 62.664 0.336 re
f
318.074 484.4601 0.336 0.336 re
f
318.41 484.4601 78.456 0.336 re
f
396.866 484.4601 0.336 0.336 re
f
397.202 484.4601 78.288 0.336 re
f
195.266 455.3961 0.336 29.064 re
f
255.074 455.3961 0.336 29.064 re
f
318.074 455.3961 0.336 29.064 re
f
396.866 455.3961 0.336 29.064 re
f
q
122.354 173.8282 72.912 554.4 re
W n
BT
/F8 1 Tf
8.4 0 0 8.4 126.05 447.3322 Tm
-0.004 Tc
0.014 Tw
[(S)-8(eru)-8(m)-271(u)-8(rea)-4( o)-4(n)]TJ
ET
Q
q
122.354 173.8282 72.912 554.4 re
W n
BT
/F8 1 Tf
8.4 0 0 8.4 126.05 437.7562 Tm
[(ad)-4(m)-7(i)-2(s)9(s)9(i)-2(on)]TJ
ET
Q
q
122.354 173.8282 72.912 554.4 re
W n
BT
/F9 1 Tf
8.4 0 0 8.4 126.05 428.0121 Tm
0.002 Tc
[(\()-5(mmo)2(l/)-1(l\))]TJ
ET
Q
q
195.602 173.8282 59.472 554.4 re
W n
BT
/F9 1 Tf
8.4 0 0 8.4 199.13 447.3322 Tm
[(6.)-10(4)]TJ
ET
Q
q
255.41 173.8282 62.664 554.4 re
W n
BT
/F9 1 Tf
8.4 0 0 8.4 258.938 447.3322 Tm
[(6.)-10(4)]TJ
ET
Q
q
318.41 173.8282 78.456 554.4 re
W n
BT
/F9 1 Tf
8.4 0 0 8.4 321.938 447.3322 Tm
0.01 Tw
[(14 \()-7(hi)-2(gh\))]TJ
ET
Q
q
397.202 173.8282 78.288 554.4 re
W n
BT
/F9 1 Tf
8.4 0 0 8.4 400.73 447.3322 Tm
[(5.)-10(5)]TJ
ET
Q
122.354 455.0602 72.912 0.336 re
f
195.266 455.0602 0.336 0.336 re
f
195.602 455.0602 59.472 0.336 re
f
255.074 455.0602 0.336 0.336 re
f
255.41 455.0602 62.664 0.336 re
f
318.074 455.0602 0.336 0.336 re
f
318.41 455.0602 78.456 0.336 re
f
396.866 455.0602 0.336 0.336 re
f
397.202 455.0602 78.288 0.336 re
f
195.266 426.1642 0.336 28.896 re
f
255.074 426.1642 0.336 28.896 re
f
318.074 426.1642 0.336 28.896 re
f
396.866 426.1642 0.336 28.896 re
f
q
122.354 173.8282 72.912 554.4 re
W n
BT
/F8 1 Tf
8.4 0 0 8.4 126.05 418.1002 Tm
-0.004 Tc
[(S)-8(eru)-8(m)-271(crea)-4(t)-11(i)-7(n)-7(i)-7(n)-7(e)]TJ
ET
Q
q
122.354 173.8282 72.912 554.4 re
W n
BT
/F9 1 Tf
8.4 0 0 8.4 126.05 408.3561 Tm
(\()Tj
ET
Q
q
122.354 173.8282 72.912 554.4 re
W n
BT
/F10 1 Tf
8.4 0 0 8.4 128.906 408.3561 Tm
Tj
ET
Q
q
122.354 173.8282 72.912 554.4 re
W n
BT
/F9 1 Tf
8.4 0 0 8.4 133.778 408.3561 Tm
0.002 Tc
[(mo)2(l/l)-1(\))]TJ
ET
Q
q
122.354 173.8282 72.912 554.4 re
W n
BT
/F9 1 Tf
8.4 0 0 8.4 126.05 398.1082 Tm
(-)Tj
ET
Q
q
122.354 173.8282 72.912 554.4 re
W n
BT
/F9 1 Tf
8.4 0 0 8.4 128.906 398.1082 Tm
0.002 Tc
[(a)6(d)2(mis)11(s)11(io)2(n)]TJ
ET
Q
q
122.354 173.8282 72.912 554.4 re
W n
BT
/F9 1 Tf
8.4 0 0 8.4 126.05 388.3641 Tm
(-)Tj
ET
Q
q
122.354 173.8282 72.912 554.4 re
W n
BT
/F9 1 Tf
8.4 0 0 8.4 128.906 388.3641 Tm
[(f)-7(ol)-2(l)-2(ow)]TJ
ET
Q
q
122.354 173.8282 72.912 554.4 re
W n
BT
/F9 1 Tf
8.4 0 0 8.4 150.914 388.3641 Tm
(-)Tj
ET
Q
q
122.354 173.8282 72.912 554.4 re
W n
BT
/F9 1 Tf
8.4 0 0 8.4 153.77 388.3641 Tm
(up)Tj
ET
Q
q
195.602 173.8282 59.472 554.4 re
W n
BT
/F9 1 Tf
8.4 0 0 8.4 199.13 418.1002 Tm
(42)Tj
ET
Q
q
195.602 173.8282 59.472 554.4 re
W n
BT
/F9 1 Tf
8.4 0 0 8.4 199.13 408.3561 Tm
(29)Tj
1.26 0 Td
0.007 Tc
[(\(a)11(t)-255(2)-233(m)5(o)7(s)]TJ
ET
Q
q
195.602 173.8282 59.472 554.4 re
W n
BT
/F9 1 Tf
8.4 0 0 8.4 199.13 398.7802 Tm
[(f)-7(ol)-2(l)-2(ow)]TJ
ET
Q
q
195.602 173.8282 59.472 554.4 re
W n
BT
/F9 1 Tf
8.4 0 0 8.4 221.138 398.7802 Tm
(-)Tj
ET
Q
q
195.602 173.8282 59.472 554.4 re
W n
BT
/F9 1 Tf
8.4 0 0 8.4 223.994 398.7802 Tm
(up\))Tj
ET
Q
q
255.41 173.8282 62.664 554.4 re
W n
BT
/F9 1 Tf
8.4 0 0 8.4 258.938 418.1002 Tm
(57)Tj
ET
Q
q
255.41 173.8282 62.664 554.4 re
W n
BT
/F9 1 Tf
8.4 0 0 8.4 258.938 408.3561 Tm
(50)Tj
1.26 0 Td
-0.004 Tc
[(\()-11(at)-266(3)-244(w)-2(eek)-4(s)]TJ
ET
Q
q
255.41 173.8282 62.664 554.4 re
W n
BT
/F9 1 Tf
8.4 0 0 8.4 258.938 398.7802 Tm
[(f)-7(ol)-2(l)-2(ow)]TJ
ET
Q
q
255.41 173.8282 62.664 554.4 re
W n
BT
/F9 1 Tf
8.4 0 0 8.4 280.946 398.7802 Tm
(-)Tj
ET
Q
q
255.41 173.8282 62.664 554.4 re
W n
BT
/F9 1 Tf
8.4 0 0 8.4 283.802 398.7802 Tm
(up\))Tj
ET
Q
q
318.41 173.8282 78.456 554.4 re
W n
BT
/F9 1 Tf
8.4 0 0 8.4 321.938 418.1002 Tm
(331)Tj
ET
Q
q
318.41 173.8282 78.456 554.4 re
W n
BT
/F9 1 Tf
8.4 0 0 8.4 321.938 408.3561 Tm
(4)Tj
ET
Q
q
318.41 173.8282 78.456 554.4 re
W n
BT
/F9 1 Tf
8.4 0 0 8.4 326.138 408.3561 Tm
0.01 Tw
[(00 \()-7(a)4(t)-262(12)-240(m)-3(os)]TJ
ET
Q
q
318.41 173.8282 78.456 554.4 re
W n
BT
/F9 1 Tf
8.4 0 0 8.4 321.938 398.7802 Tm
[(f)-7(ol)-2(l)-2(ow)]TJ
ET
Q
q
318.41 173.8282 78.456 554.4 re
W n
BT
/F9 1 Tf
8.4 0 0 8.4 343.946 398.7802 Tm
(-)Tj
ET
Q
q
318.41 173.8282 78.456 554.4 re
W n
BT
/F9 1 Tf
8.4 0 0 8.4 346.802 398.7802 Tm
(up\))Tj
ET
Q
q
397.202 173.8282 78.288 554.4 re
W n
BT
/F9 1 Tf
8.4 0 0 8.4 400.73 418.1002 Tm
(62)Tj
ET
Q
q
397.202 173.8282 78.288 554.4 re
W n
BT
/F9 1 Tf
8.4 0 0 8.4 400.73 408.3561 Tm
(56)Tj
1.26 0 Td
-0.004 Tc
[(\()-11(at)-266(1)-244(w)-2(eek)-4( )]TJ
ET
Q
q
397.202 173.8282 78.288 554.4 re
W n
BT
/F9 1 Tf
8.4 0 0 8.4 400.73 398.7802 Tm
[(f)-7(ol)-2(l)-2(ow)]TJ
ET
Q
q
397.202 173.8282 78.288 554.4 re
W n
BT
/F9 1 Tf
8.4 0 0 8.4 422.738 398.7802 Tm
(-)Tj
ET
Q
q
397.202 173.8282 78.288 554.4 re
W n
BT
/F9 1 Tf
8.4 0 0 8.4 425.594 398.7802 Tm
(up\))Tj
ET
Q
122.354 425.8282 72.912 0.336 re
f
195.266 425.8282 0.336 0.336 re
f
195.602 425.8282 59.472 0.336 re
f
255.074 425.8282 0.336 0.336 re
f
255.41 425.8282 62.664 0.336 re
f
318.074 425.8282 0.336 0.336 re
f
318.41 425.8282 78.456 0.336 re
f
396.866 425.8282 0.336 0.336 re
f
397.202 425.8282 78.288 0.336 re
f
195.266 386.5161 0.336 39.312 re
f
255.074 386.5161 0.336 39.312 re
f
318.074 386.5161 0.336 39.312 re
f
396.866 386.5161 0.336 39.312 re
f
Q
Q
Q
/GS1 gs
q
BT
/F1 1 Tf
9.5 0 0 9.5 40.024 297.5035 Tm
0 0 0 1 k
(C)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F1 1 Tf
7.125 0 0 7.125 46.8823 297.5035 Tm
0 0 0 1 k
0.001 Tc
(ASE)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F1 1 Tf
9.5 0 0 9.5 63.3517 297.5035 Tm
0 0 0 1 k
0.001 Tc
(1)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F0 1 Tf
9.5 0 0 9.5 52.024 282.5035 Tm
0 0 0 1 k
(A)Tj
1.02576 0.00001 TD
0.109 Tw
(previously healthy)Tj
7.45837 0.00001 TD
-0.0001 Tc
(,)Tj
0.60853 0 Td
0 Tc
[(eight-year)20(-old boy presented with a 5)]TJ
-10.35581 -1.15791 TD
0.155 Tw
(day history of lethar)Tj
8.52674 0.00001 TD
(gy)Tj
0.93506 0.00001 TD
-0.0001 Tc
(,)Tj
0.65469 0 Td
0 Tc
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1.26316 -1.15789 TD
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0 0 0 1 k
0.02 Tc
0.589 Tw
(Figure 2:)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F3 1 Tf
8.5 0 0 8.5 424.4183 610.3153 Tm
0 0 0 1 k
0.02 Tc
0.589 Tw
[(Neur)37(oimaging of Case 2 shows)]TJ
-6.4039 -1.05882 TD
0.008 Tc
0.367 Tw
[(abnormalities consistent with r)37(eversible posterior)]TJ
T*
0 Tc
0.3 Tw
[(leukoencephalopathy)55(. CT)-533(without contrast material)]TJ
T*
0.07 Tw
[((C- CT) at pr)37(esentation demonstrates a small ar)37(ea of)]TJ
T*
0.099 Tw
[(hypodensity \(short arr)37(ow\) in the right occipital lobe.)]TJ
T*
0.009 Tc
0.366 Tw
[(MRI was performed four hours later)111(. )18(Axial and)]TJ
0.0199 Tc
(c)'
0.46388 -0.00001 TD
0.02 Tc
0.434 Tw
[(or)37(onal fast fluid-attenuated inversion r)37(ecovery)]TJ
-0.46388 -1.05882 TD
0.011 Tc
0.364 Tw
[(images \(FLAIR,TR 8500/TE 93/TI 2200/ETL)-607(15\))]TJ
T*
0.001 Tc
0.374 Tw
[(r)37(eveal several ar)37(eas of pr)37(edominantly subcor)-1(tical)]TJ
T*
0 Tc
0.117 Tw
[(hyperintensity in right occipito-parietal r)37(egion. Most)]TJ
T*
0.037 Tw
[(of the lesions have no r)37(estricted diffusion except for a)]TJ
T*
0.057 Tw
[(small ar)37(ea in the occipital cortex \(arr)37(owhead\), which)]TJ
T*
0.01 Tc
0.365 Tw
(demonstrates hyperintensity on diffusion-weighted)Tj
T*
0 Tc
0.079 Tw
(images \(DWI, b = 1000 s/mm)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F3 1 Tf
5.61 0 0 5.61 473.9539 496.1203 Tm
0 0 0 1 k
(2)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F3 1 Tf
8.5 0 0 8.5 476.7589 493.3153 Tm
0 0 0 1 k
(\))Tj
0.66162 0 Td
0.079 Tw
(and appears dark on)Tj
-13.22324 -1.05882 TD
0.02 Tc
0.37 Tw
[(appar)37(ent diffusion coefficients (ADC) map. The)]TJ
T*
0 Tc
0.1 Tw
(lesions do not enhance on post-contrast T1-weighted)Tj
T*
0.079 Tw
[(sequence \(\(Gd+ T1W)92(, TR 635/TE 17\). On the single-)]TJ
T*
0.131 Tw
[(voxel MR spectr)37(oscopy (MRS, TE = 270 msec) over)]TJ
T*
0.166 Tw
(the right occipital lesion, a small peak of lactate is)Tj
T*
0.025 Tw
[(seen \(long arr)37(ow\).)]TJ
ET
/GS2 gs
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39.024 331.332 297.425 395.01 re
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(THE)Tj
2.21865 0 Td
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[(CANADIAN JOURNAL)-238(OF NEUROLOGICAL)-238(SCIENCES)]TJ
-2.21865 -80.04603 TD
(320)Tj
ET
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/GS2 gs
/GS1 gs
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BT
/F0 1 Tf
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[(presentation which was treated with cephalexin. )55(At the time of)]TJ
0 -1.1579 TD
0.105 Tw
(presentation with her seizure, it was noted that she had passed)Tj
0 -1.15789 TD
0.086 Tw
(\322tea-colored\323 urine for the preceding three days. On exam, she)Tj
T*
0.238 Tw
(was afebrile and had a blood pressure of 145/104. She was)Tj
0 -1.1579 TD
0.018 Tc
0.357 Tw
(irritable but roused easily with stimulation. Neurological)Tj
0 -1.15789 TD
-0.0001 Tc
(e)Tj
0.44391 -0.00001 TD
0 Tc
0.025 Tw
(xamination was unremarkable except for a left Babinski sign.)Tj
0.81925 -1.15789 TD
0.374 Tw
[(Her head CT)-607(was normal but MRI showed )18(T2 hyper)19(-)]TJ
-1.26316 -1.15789 TD
0.09 Tw
[(intensities predominantly af)18(fecting the subcortical white matter)]TJ
0 -1.1579 TD
0.07 Tw
(in occipital and posterior parietal and temporal regions, as well)Tj
0 -1.15789 TD
[(as the right cerebellar hemisphere. Dif)18(fuse background slowing)]TJ
T*
-0.023 Tw
[(predominantly af)18(fecting posterior head regions was seen on EEG)]TJ
0 -1.1579 TD
0.286 Tw
[(but there were no epileptiform dischar)18(ges. Blood and urine)]TJ
0 -1.15789 TD
0.029 Tw
[(results are shown in )18(T)70(able 1. )55(ASOT)-262(was elevated at 640 IU/mL.)]TJ
T*
0.025 Tw
(CSF analysis was unremarkable.)Tj
1.26316 -1.1579 TD
0.02 Tc
0.613 Tw
[(She was diagnosed with post-streptococcal glomer)20(-)]TJ
-1.26316 -1.15789 TD
0 Tc
0.046 Tw
[(ulonephritis. She received 2 mg lorazepam IV)-278(followed by a 15)]TJ
T*
0.08 Tw
[(mg/kg load of IV)-312(phenytoin at the time of her seizure, but was)]TJ
0 -1.1579 TD
0.02 Tc
0.437 Tw
(not maintained on antiepileptic medication and had no)Tj
T*
0 Tc
0.178 Tw
(subsequent events. Her hypertension was treated acutely with)Tj
0 -1.15789 TD
0.025 Tw
(nifedipine and she was dischar)Tj
12.35464 -0.00001 TD
(ged home on amlodipine.)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F1 1 Tf
9.5 0 0 9.5 40.024 486.024 Tm
0 0 0 1 k
(D)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F1 1 Tf
7.125 0 0 7.125 46.8823 486.024 Tm
0 0 0 1 k
0.001 Tc
(ISCUSSION)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F0 1 Tf
9.5 0 0 9.5 52.024 471.024 Tm
0 0 0 1 k
0.179 Tw
(The diagnosis of PRES should be considered in any child)Tj
-1.26316 -1.15789 TD
0.114 Tw
(presenting with new onset seizures, encephalopathy and visual)Tj
0 -1.1579 TD
-0.027 Tw
[(symptoms. )18(This condition responds promptly to adequate control)]TJ
T*
0.124 Tw
(of blood pressure, and the long-term neurological prognosis is)Tj
0 -1.15789 TD
0.077 Tw
(extremely favorable. Prior reported cases of PRES due to renal)Tj
0 -1.1579 TD
0.005 Tc
0.37 Tw
(disease in children have predominantly occurred after the)Tj
T*
0 Tc
0.016 Tw
(diagnosis of the renal disease was established.)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F0 1 Tf
6.27 0 0 6.27 216.3563 408.159 Tm
0 0 0 1 k
(2-6)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F0 1 Tf
9.5 0 0 9.5 227.2405 405.024 Tm
0 0 0 1 k
0.016 Tw
[(However)40(, three)]TJ
-19.707 -1.15789 TD
0.134 Tw
(prior case reports describe previously well children presenting)Tj
0 -1.1579 TD
0.117 Tw
(with symptoms of PRES, who were ultimately diagnosed with)Tj
T*
0.02 Tc
0.394 Tw
(poststreptococcal glomerulonephritis.)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F0 1 Tf
6.27 0 0 6.27 193.7747 375.159 Tm
0 0 0 1 k
0.02 Tc
(7-10)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F0 1 Tf
9.5 0 0 9.5 211.9073 372.024 Tm
0 0 0 1 k
0.02 Tc
0.394 Tw
(The diagnosis of)Tj
-18.09298 -1.15789 TD
0 Tc
0.134 Tw
(poststreptococcal glomerulonephritis in three of our cases was)Tj
0 -1.1579 TD
0.015 Tw
(made based on presentation with a nephritic picture, high )Tj
23.23528 0 TD
0 Tw
(ASOT)Tj
-23.23528 -1.1579 TD
0.28 Tw
(levels, low C3 and complete resolution of renal disease on)Tj
0 -1.15789 TD
0.088 Tw
(follow-up. Our four cases from a single centre suggest that the)Tj
0 -1.1579 TD
0.19 Tw
(association between PRES undiagnosed renal disease such as)Tj
T*
0.175 Tw
(poststreptococcal glomerulonephritis is not rare, and probably)Tj
0 -1.15789 TD
0.001 Tc
0 Tw
(under)Tj
2.26256 0 TD
0.374 Tw
(-recognized - investigation for renal disease must be)Tj
-2.26256 -1.1579 TD
0 Tc
0.025 Tw
(pursued with this clinical presentation. )Tj
1.26316 -1.15789 TD
-0.007 Tw
(The pathophysiology of PRES involves vasogenic rather than)Tj
-1.26316 -1.1579 TD
-0.03 Tw
(cytotoxic edema.)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F0 1 Tf
6.27 0 0 6.27 104.625 265.159 Tm
0 0 0 1 k
(1)Tj
0.44415 0.00001 TD
(1)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F0 1 Tf
9.5 0 0 9.5 112.6305 262.0239 Tm
0 0 0 1 k
-0.03 Tw
(Cerebral autoregulation maintains a relatively)Tj
-7.64279 -1.15789 TD
0.014 Tw
(constant cerebral blood flow over a range of mean arterial blood)Tj
T*
0.077 Tw
(pressure, thus protecting the brain from acute changes in blood)Tj
0 -1.1579 TD
0.02 Tc
0.737 Tw
[(pressure. However)40(, at high mean arterial pressures,)]TJ
0 -1.15789 TD
0.012 Tc
0.363 Tw
(autoregulation fails, leading to arteriolar vasodilation and)Tj
T*
0 Tc
0.241 Tw
(endothelial dysfunction, resulting in disruption of the blood-)Tj
0 -1.1579 TD
0.019 Tc
0.356 Tw
[(brain barrier and capillary leakage. )17(The white )1(matter is)]TJ
0 -1.15789 TD
0 Tc
0.291 Tw
[(predominantly af)18(fected as it is less tightly packed than the)]TJ
T*
0 Tw
(cortex. )Tj
3.0544 0.00001 TD
0.074 Tw
(The posterior brain appears to be preferentially af)Tj
20.34935 0.00001 TD
0 Tw
(fected)Tj
-23.40375 -1.15791 TD
0.055 Tw
(because of diminished sympathetic innervation.)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F0 1 Tf
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0 0 0 1 k
(12)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F0 1 Tf
9.5 0 0 9.5 232.529 163.0239 Tm
0 0 0 1 k
0.055 Tw
(Children with)Tj
-20.26369 -1.15789 TD
0.025 Tw
(acute onset of hypertension are probably more at risk than those)Tj
T*
0.034 Tw
(with chronic hypertension, because they have not yet developed)Tj
0 -1.1579 TD
0.116 Tw
(adaptive vascular changes. Posterior reversible encephalopathy)Tj
0 -1.15789 TD
0.05 Tw
[(syndrome can also be seen with immunosuppressive drugs. )18(The)]TJ
T*
0.191 Tw
(pathophysiology in this setting is less clear)Tj
18.27243 0.00001 TD
-0.0001 Tc
(,)Tj
0.69136 0 Td
0 Tc
(but may involve)Tj
-18.96379 -1.15791 TD
0.257 Tw
(damage to the vascular endothelium resulting in vasospasm,)Tj
0 -1.15789 TD
0.123 Tw
(reduced tissue perfusion, activation of the coagulation cascade)Tj
T*
0.025 Tw
(and extravasation of fluid.)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F0 1 Tf
6.27 0 0 6.27 140.4448 78.159 Tm
0 0 0 1 k
(1)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F0 1 Tf
9.5 0 0 9.5 321.16 717.0228 Tm
0 0 0 1 k
0.107 Tw
[(The dif)18(ferential diagnosis of acute seizures, encephalopathy)]TJ
-1.26316 -1.15789 TD
0.121 Tw
(and focal or multifocal white matter abnormalities on imaging)Tj
T*
0.02 Tc
0.751 Tw
(include infarction, vasculitis, demyelinating disorders,)Tj
0 -1.1579 TD
0 Tc
-0.003 Tw
[(encephalitis and mitochondrial cytopathies. )18(While neuroimaging)]TJ
0 -1.15789 TD
-0.015 Tw
(abnormalities in PRES are seen maximally in the white matter of)Tj
T*
0.012 Tw
(the parietal and occipital regions, lesions can be more extensive,)Tj
0 -1.1579 TD
0.233 Tw
(spreading into the cerebellum, frontal regions, basal ganglia,)Tj
0 -1.15789 TD
0.023 Tw
(thalami, brain stem and corpus callosum, suggesting a diagnosis)Tj
T*
0.12 Tw
(of demyelinating disease.)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F0 1 Tf
6.27 0 0 6.27 408.257 632.1578 Tm
0 0 0 1 k
(13)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F0 1 Tf
9.5 0 0 9.5 418.0449 629.0228 Tm
0 0 0 1 k
0.12 Tw
(Co-existent cortical involvement is)Tj
-11.46157 -1.1579 TD
0.105 Tw
(common, occurring in up to 94%.)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F0 1 Tf
6.27 0 0 6.27 442.0816 621.1578 Tm
0 0 0 1 k
(1)Tj
0.5 -0.00001 TD
(,14,15)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F0 1 Tf
9.5 0 0 9.5 463.7381 618.0228 Tm
0 0 0 1 k
0.105 Tw
(Although abnormalities)Tj
-16.27138 -1.15789 TD
0.01 Tc
0.365 Tw
(may be seen on computed tomography (CT) scan, fluid-)Tj
T*
0 Tc
-0.024 Tw
(attenuated inversion recovery (FLAIR) MRI sequences are much)Tj
0 -1.1579 TD
0.069 Tw
(better at showing the extent of the hyperintense lesions and the)Tj
0 -1.15789 TD
0.157 Tw
[(degree of cortical involvement. )18(The calcarine and paramedian)]TJ
T*
0.311 Tw
(part of the occipital lobe are classically spared, helping to)Tj
0 -1.1579 TD
0.02 Tc
0.355 Tw
(distinguish PRES from bilateral posterior cerebral artery)Tj
0 -1.15789 TD
0 Tc
0 Tw
(infarction.)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F0 1 Tf
6.27 0 0 6.27 348.4588 544.1578 Tm
0 0 0 1 k
(1)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F0 1 Tf
9.5 0 0 9.5 355.425 541.0228 Tm
0 0 0 1 k
0.153 Tw
[(Dif)18(fusion-weighted MR imaging (DWI) sequences)]TJ
-4.87 -1.15789 TD
0.207 Tw
(are helpful to discriminate mitochondrial encephalopathy and)Tj
0 -1.1579 TD
0.041 Tw
(venous infarction, in which the lesions typically show restricted)Tj
0 -1.15789 TD
0 Tw
(dif)Tj
1.09277 0.00001 TD
0.069 Tw
[(fusion. )18(The majority of lesions in PRES show iso or slightly)]TJ
-1.09277 -1.1579 TD
0.216 Tw
[(hyperintense signal on DWI but increased apparent dif)18(fusion)]TJ
T*
0 Tw
(coef)Tj
1.70263 0 TD
0.038 Tw
(ficient (ADC) consistent with vasogenic edema, as opposed)Tj
-1.70263 -1.1579 TD
0.053 Tw
[(to decreased )55(ADC values usually seen with infarction.)]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F0 1 Tf
6.27 0 0 6.27 518.4654 478.1578 Tm
0 0 0 1 k
(1)Tj
0.49999 -0.00001 TD
(5)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F0 1 Tf
9.5 0 0 9.5 527.6177 475.0228 Tm
0 0 0 1 k
[(Rarely)65(,)]TJ
-22.99555 -1.1579 TD
0.35 Tw
(very high tissue perfusion pressure may lead to decreased)Tj
0 -1.15789 TD
0.369 Tw
(cerebral blood flow)Tj
8.50305 0 TD
-0.0001 Tc
(,)Tj
0.86926 0 Td
0 Tc
(with resulting ischemia and cytotoxic)Tj
-9.37231 -1.1579 TD
0.105 Tw
(edema, manifested by an area of increased signal on DWI and)Tj
T*
-0.032 Tw
[(decreased signal on the )55(ADC map.)]TJ
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F0 1 Tf
6.27 0 0 6.27 439.0224 434.1578 Tm
0 0 0 1 k
(1)Tj
0.5 -0.00001 TD
(5)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F0 1 Tf
9.5 0 0 9.5 447.1963 431.0228 Tm
0 0 0 1 k
-0.032 Tw
(The lesions of PRES usually)Tj
-14.53013 -1.15789 TD
0.092 Tw
[(do not enhance on post-contrast images. )18(The MR spectroscopy)]TJ
0 -1.1579 TD
0.173 Tw
(results have varied, but evidence of subtle metabolic changes)Tj
T*
0.101 Tw
(including high lactate)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F0 1 Tf
6.27 0 0 6.27 393.3881 401.1578 Tm
0 0 0 1 k
(16)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F0 1 Tf
9.5 0 0 9.5 402.9928 398.0228 Tm
0 0 0 1 k
0.101 Tw
(and increased choline and creatine and)Tj
-9.87714 -1.15789 TD
0.025 Tw
(mildly decreased N-acetyl aspartate)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F0 1 Tf
6.27 0 0 6.27 445.6929 390.1578 Tm
0 0 0 1 k
(17)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F0 1 Tf
9.5 0 0 9.5 454.5754 387.0228 Tm
0 0 0 1 k
0.025 Tw
(has been reported.)Tj
-14.04373 -1.1579 TD
0.176 Tw
(In conclusion, blood pressure is an important vital sign to)Tj
-1.26316 -1.1579 TD
0.325 Tw
(attend to in all children presenting with visual complaints,)Tj
0 -1.15789 TD
0.255 Tw
(seizures and/or encephalopathy)Tj
12.99384 0 TD
-0.0001 Tc
(.)Tj
0.75456 0 Td
0 Tc
(If elevated, the diagnosis of)Tj
-13.7484 -1.1579 TD
0.209 Tw
(PRES should be strongly considered and a workup for renal)Tj
T*
0.241 Tw
(disease pursued. Prompt treatment of hypertension results in)Tj
0 -1.15789 TD
0.025 Tw
(resolution of neurological symptoms. )Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F1 1 Tf
9.5 0 0 9.5 309.16 299.0228 Tm
0 0 0 1 k
(R)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F1 1 Tf
7.125 0 0 7.125 316.0183 299.0228 Tm
0 0 0 1 k
0.001 Tc
(EFERENCES)Tj
ET
Q
/GS2 gs
/GS1 gs
q
BT
/F0 1 Tf
8.5 0 0 8.5 309.16 286.0228 Tm
0 0 0 1 k
0.038 Tw
[(1.)-1132(Hinchey J, Chaves C, )55(Appignani B, Breen J, Pao L, )17(W)80(ang )55(A, et al.)]TJ
3.05882 -1.05882 TD
0.368 Tw
[(A)-563(reversible posterior leukoencephalopathy syndrome. New)]TJ
T*
0.025 Tw
(Engl J Med. 1996;334:494-500.)Tj
-3.05882 -1.05882 TD
0.001 Tw
[(2.)-1132(Ohta )17(T)75(, )-1(Sakano )18(T)74(, Shiotsu M, Furue )18(T)74(, Ohtani H, Kinoshita )37(Y)129(, et al.)]TJ
3.05882 -1.05882 TD
0.001 Tc
0.374 Tw
(Reversible posterior leukoencephalopathy in a patient with)Tj
T*
0 Tc
0.025 Tw
[(W)80(egener granulomatosis. Pediatr Nephr)55(. 2004;19:442-4.)]TJ
-3.05882 -1.05882 TD
0.02 Tc
0.589 Tw
[(3)20(.)-1112(Soylu )55(A, Kavukcu S, )17(T)35(urkmen M, )55(Akbas )37(Y)129(. Posterior)]TJ
3.05882 -1.05882 TD
0.37 Tw
(leukoencephalopathy syndrome in poststreptococcal acute)Tj
T*
0 Tc
0.025 Tw
[(glomerulonephritis. Pediatr Nephr)55(. 2001;16:601-3.)]TJ
-3.05882 -1.05882 TD
0.17 Tw
[(4.)-1132(Ozcakar ZB, Ekim M, Fitoz S, )17(T)70(eber S, Hizel S, )55(Acar B, et al.)]TJ
3.05882 -1.05882 TD
0.071 Tw
(Hypertension induced reversible posterior leukoencephalopathy)Tj
T*
-0.018 Tw
[(syndrome: a report of two cases. Eur J Pediatr)55(. 2004;163:728-30.)]TJ
-3.05882 -1.05882 TD
0.242 Tw
[(5.)-1132(Ohtomo )36(Y)129(, )18(T)70(akada M, Fujinaga S, Murakami H, )37(Y)100(amashiro )37(Y)129(.)]TJ
3.05882 -1.05882 TD
0.012 Tw
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