Paroxysmal hypertension with reversible posterior leukoencephalopathy syndrome in a child: an unresolved riddle

Mili Thomas, Veena V. Nair, Lekha Hrishikesan, Kamala Swarnam


 Nine year old girl was presented with paroxysmal episodes of hypertensive emergency. She was asymptomatic with normal blood pressure without antihypertensives in between the episodes. MRI brain was suggestive of reversible posterior leukoencephalopathy.  Acute episodes were managed with IV labetalol infusion and amlodipine. She was evaluated extensively to find out the etiology of hypertension. Cardiac and renal causes were ruled out. Work up for pheochromocytoma, hyperaldosteronism, porphyria and vasculitis were negative. The case is reported in view of the rare presentation and the leukoencephalopathy noted in this case.


High blood pressure, Hypertensive emergency, Paroxysmal hypertension, Pseudopheochromocytoma children, Reversible posterior leukoencephalopathy

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Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo Jr JL, et al. The seventh report of the joint national committee on prevention, detection, evaluation, and treatment of high blood pressure: the JNC 7 report. Jama. 2003;289(19):2560-71.

Flanigan JS, Vitberg D. Hypertensive emergency and severe hypertension: what to treat, who to treat, and how to treat. Med Clinics. 2006;90(3):439-51.

Pacak K, Linehan WM, Eisenhofer G, Walther MM, Goldstein DS. Recent advances in genetics, diagnosis, localization, and treatment of pheochromocytoma. Anna Int Med. 2001;134(4):315-29.

Lande M B. Systemic hypertension In: R. Kliegman, B. Stanton, J. St.Geme III, N. Schor and R. Behrman, ed., Nelson Textbook of Pediatrics, 20th ed. 2016. Philadelphia: Elsevier;2294.

Mann SJ. Severe paroxysmal hypertension (pseudopheochromocytoma): understanding the cause and treatment. Arch int med. 1999;159(7):670-4.

Kuchel OT. Pseudopheochromocytoma. Hypertens. 1985;7(1):151-8.

Balon R, Ortiz A, Pohl R, Yeragani VK. Heart rate and blood pressure during placebo-associated panic attacks. Psychosomatic med. 1988 Jul.

Fugate JE, Rabinstein AA. Posterior reversible encephalopathy syndrome: clinical and radiological manifestations, pathophysiology, and outstanding questions. The Lancet Neurol. 2015;14(9):914-25.