Early prognostic factors for acute encephalopathy with reduced subcortical diffusion.

Abstract

OBJECTIVE:

The aim of this study was to determine the prognostic factors for acute encephalopathy with reduced diffusion (AED) during the acute phase through retrospective case evaluation.

METHODS:

The participants included 23 patients with AED. The diagnosis of AED was based on their clinical course and radiological findings. We divided the patients into severe and non-severe groups based on the neurodevelopmental outcome. The severe group included seven patients (median age, 21 months; range, 6-87 months) and the non-severe group included 16 patients (19 months, 9-58 months). Clinical symptoms, laboratory data and electroencephalogram (EEG) findings within 48 h from the initial seizure onset were compared between the two groups to identify neurological outcome predictors.

RESULTS:

The incidence of coma 12-24 h after onset, serum creatinine (Cr) levels within 2 h after onset, maximum aspartate aminotransferase (AST) levels within 24 h after onset, and the rate of electrographic seizures in EEG were significantly higher in the severe group (Coma, 80%; Cr, 0.40 mg/dl, 0.37-0.73; AST, 363 IU/L, 104-662; electrographic seizures, 80%) than the non-severe group (Coma, 0%; Cr, 0.29 mg/dL, 0.19-0.45; AST, 58.5 IU/L, 30-386; electrographic seizures, 0%).

CONCLUSIONS:

Coma 12-24 h after onset, elevation of Cr levels within 2 h after onset, elevation of AST levels within 24 h after onset, and non-convulsive status epileptics (NCSE) in comatose patients were early predictors of severe AED. Patients in a coma after a febrile seizure should be checked for NCSE signs in EEG to terminate NCSE without delay.

• Authors: Tetsuhiro Fukuyama, Shouko Yamauchi, Shunsuke Amagasa, Yuka Hattori, Taku Sasaki, Hideko Nakajima, Yuko Takei, Jiu Okuno, Yuka Misawa, Noboru Fueki, Masatomo Kitamura, Hikoro Matsui, Yuji Inaba, Shinichi Hirabayashi
• Journal: Brain & development (Brain Dev) Vol. 40 Issue 8 Pg. 707-713 (Sep 2018) ISSN: 1872-7131 [Electronic] Netherlands
• PMID: 29716832 (Publication Type: Journal Article)
• Copyright: Copyright © 2018 The Japanese Society of Child Neurology. Published by Elsevier B.V. All rights reserved.

Chemical References

• Biomarkers
• Creatinine

Topics

• Biomarkers (blood)
• Brain (physiopathology)
• Brain Diseases (diagnosis, epidemiology)
• Child
• Child, Preschool
• Creatinine (blood)
• Electroencephalography
• Humans
• Incidence
• Infant
• Prognosis
• Severity of Illness Index
• Time Factors