Differences of Clinical Manifestations According to the Patterns of Brain Lesions in Acute Encephalopathy with Reduced Diffusion in the Bilateral Hemispheres

Okumura, Akihisa; Kidokoro, Hiroyuki; Tsuji, Takeshi; Suzuki, Michitaka; Kubota, Tetsuo; Kato, Toru; Komatsu, Masaaki; Shono, Tetsuo; Hayakawa, Fumio; Shimizu, Toshiaki; Morishima, Tsuneo

doi:10.3174/ajnr.a1431

Cited by 51 publications

(50 citation statements)

References 19 publications

(31 reference statements)

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“…In contrast to the previous studies revealing an association of poor outcome with imaging abnormalities [2][3][4][5], our results did not support such an association in the majority of patients. This discrepancy may be explained by our use of a comparatively more systematic imaging scoring method covering the entire brain, various and different causative agents in our patients, and a relatively large number of patients in our cohort.…”

Section: Discussioncontrasting

confidence: 86%

“…We did not directly compare the outcome of the LRD (+) group with that of the LRD (−) group, because a potential interaction may exist between diffusion of the lesions and the extent of the lesions, which was represented by the imaging score in our study. The extent of abnormality is generally believed to be related to the outcome of patients in encephalitis [2][3][4][5]. In order to delineate such potential interaction, we used logistic regression analysis to evaluate the association of LRD with the outcome of these two groups of patients.…”

Section: Discussionmentioning

confidence: 99%

“…Although the mortality of patients with encephalitis has declined over the years, patients who have recovered from encephalitis often live with significant neurological sequelae. The extent of neuroimaging abnormalities has been correlated with patient outcome, revealing that the patients with a worse outcome had abnormal MR findings [2], diffuse lesions [3], deep white matter involvement [4], and brain stem involvement [5].…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Childhood encephalitis: relationship between diffusion abnormalities and clinical outcome

Wong¹,

Lin²,

Toh³

et al. 2014

Neuroradiology

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Section: Discussioncontrasting

confidence: 86%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Childhood encephalitis: relationship between diffusion abnormalities and clinical outcome

Wong¹,

Lin²,

Toh³

et al. 2014

Neuroradiology

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“…Recently, several subtypes of acute encephalopathy have been categorized on the basis of MRI findings and clinical manifestations: acute necrotizing encephalopathy (ANE) [11], [12], hemorrhagic shock and encephalopathy syndrome (HSES) [2], clinically mild encephalitis/encephalopathy with reversible splenial lesion (MERS) [10], and acute encephalopathy with biphasic seizures and late reduced diffusion (AESD) [6], [8], [10]. The characteristic findings, outcome, recommended treatment and genetic background for each subtype are gradually becoming clear [2], [7], [9], [10], [12]–[17], but the pathological mechanisms are still uncertain, and many cases of acute encephalopathy are unspecific and could not be directly categorized into the above subtypes [1], [3], [7], [15].…”

Section: Introductionmentioning

confidence: 99%

Analysis of Multiple B-Value Diffusion-Weighted Imaging in Pediatric Acute Encephalopathy

et al. 2013

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Acute encephalopathy is a disease group more commonly seen in children. It is often severe and has neurological sequelae. Imaging is important for early diagnosis and prompt treatment to ameliorate an unfavorable outcome, but insufficient sensitivity/specificity is a problem. To overcome this, a new value (fraction of high b-pair (FH)) that could be processed from clinically acceptable MR diffusion-weighted imaging (DWI) with three different b-values was designed on the basis of a two-compartment model of water diffusion signal attenuation. The purpose of this study is to compare FH with the apparent diffusion coefficient (ADC) regarding the detectability of pediatric acute encephalopathy. We retrospectively compared the clinical DWI of 15 children (1–10 years old, mean 2.34, 8 boys, 7 girls) of acute encephalopathy with another 16 children (1–11 years old, mean 4.89, 9 boys, 7 girls) as control. A comparison was first made visually by mapping FH on the brain images, and then a second comparison was made on the basis of 10 regions of interest (ROIs) set on cortical and subcortical areas of each child. FH map visually revealed diffusely elevated FH in cortical and subcortical areas of the patients with acute encephalopathy; the changes seemed more diffuse in FH compared to DWI. The comparison based on ROI revealed elevated mean FH in the cortical and subcortical areas of the acute encephalopathy patients compared to control with significant difference (P<0.05). Similar findings were observed even in regions where the findings of DWI were slight. The reduction of mean ADC was significant in regions with severe findings in DWI, but it was not constant in the areas with slighter DWI findings. The detectability of slight changes of cortical and subcortical lesions in acute encephalopathy may be superior in FH compared to ADC.

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“…As reduced subcortical diffusion may also present in patients who are not completely compatible with the features of AESD, the term acute encephalopathy with reduced subcortical diffusion (AED) was recently proposed [3,4]. AED covers a spectrum including typical AESD and atypical AESD with a monophasic clinical course [4,5], with preceding partial SE or prolonged partial epilepsy rather than febrile seizures [6], or with a predominantly unilateral hemispheric location [7].…”

Section: Introductionmentioning

confidence: 99%

Perfusion imaging with arterial spin labeling in acute encephalopathy with reduced subcortical diffusion following secondary generalized status epilepticus

Takahara

Morioka

Shimogawa

et al. 2017

E&S

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Magnetic resonance perfusion imaging with arterial spin labeling (ASL) can provide valuable information on the circulatory changes associated with status epilepticus (SE). We report a case of a girl with an old brain abscess in the right frontal lobe who developed secondary generalized SE twice (at 3 and 4 years of age). Although she made a full recovery after the first SE, she developed acute encephalopathy with reduced subcortical diffusion (AED) following the second SE with a monophasic clinical course. We compared the ASL findings on day 4 after onset of each SE. After the first SE, ASL revealed postictal hypoperfusion in bilateral anterior circulation territories. By contrast, after the second SE, there was a marked increase in ASL signals of the entire cortex, particularly in the right fronto-parietal lobe, which corresponded to the area of reduced subcortical diffusion. Prolonged cortical hyperperfusion may have caused relative ischemia of the subcortex. As there is growing evidence that oligodendrocytes are selectively vulnerable to ischemia via glutamatemediated excitotoxicity, our findings suggest that white matter ischemia may cause axonal injury in this case. Finding of prolonged cortical ASL hyperperfusion around day 4 after SE onset may be important for the detection of reduced subcortical diffusion.

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Differences of Clinical Manifestations According to the Patterns of Brain Lesions in Acute Encephalopathy with Reduced Diffusion in the Bilateral Hemispheres

Cited by 51 publications

References 19 publications

Childhood encephalitis: relationship between diffusion abnormalities and clinical outcome

Childhood encephalitis: relationship between diffusion abnormalities and clinical outcome

Analysis of Multiple B-Value Diffusion-Weighted Imaging in Pediatric Acute Encephalopathy

Perfusion imaging with arterial spin labeling in acute encephalopathy with reduced subcortical diffusion following secondary generalized status epilepticus

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