Apnea and delirious behavior caused by mild encephalitis/encephalopathy with reversible splenial lesion complicated with rotavirus infection

Ohnishi, Takuma; Mishima, Yoshinori; Shinozuka, Shunsuke; Shikoro, Nobuaki; Kamimaki, Isamu

doi:10.1111/ped.13582

Cited by 2 publications

(2 citation statements)

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“… 16 It has also been noted that 33% of patients with RV-induced encephalopathy may develop seizures. 15 Similarly, 2 of the 3 patients with RV-induced encephalopathy in our study had prolonged seizures.…”

Section: Discussionmentioning

confidence: 50%

“…Complications of the central nervous system occur in about 2-4% of RV infections. 15 Reversible signal changes in the splenium of the corpus callosum were detected on MRI in patients with RV-associated encephalitis or encephalopathy. 13 ,15, 16 The mechanism of this reversible lesion may be the development of intramyelinic axonal edema and/or the development of an inflammatory infiltrate.…”

Section: Discussionmentioning

confidence: 98%

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Clinical Features and Outcomes of Children Admitted to the PICU due to Rotavirus Infection

Gün¹,

Kendirli²,

Öztürk³

et al. 2021

Turk Arch Pediatrics

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Objectives: In this study, we aimed to evaluate the clinical and laboratory features of the patients with rotavirus (RV) antigen positivity on or following admission to the pediatric intensive care unit (PICU). Methods: Patients admitted to the PICU due to community-acquired rotavirus (CA-RV) or hospital-acquired rotavirus (HA-RV)-induced gastroenteritis between January 1, 2013, and December 31, 2019 were evaluated. Results: Thirty-four patients with a mean age of 14.00 ± 19.17 months were enrolled. Forty-four percent were girls. Twenty (58.8%) patients had a history of chronic diseases. Nine (26.5%) patients had CA-RV and 25 (73.5%) patients had HA-RV infection. RV antigens were simultaneously found in 44.1% ( n = 14) of the other patients at the time of diagnosis. In the study sample, 5 patients had hyponatremia, 8 had hypernatremia, 6 had hypokalemia, 4 had hypoalbuminemia, 21 had leukocytosis, 2 had leukopenia and 3 had thrombocytopenia, and 17 had elevated C-reactive protein (CRP) levels. Three patients had seizures, 1 patient had cardiac arrest, and 2 patients had secondary bacteremia. The mean (SD) PICU length of stay was 6 (6.02) with CA-RV gastroenteritis. All CA-RV patients survived, but 8 of the HA-RV patients succumbed to causes other than RV. Conclusion: RV-related PICU admission is not rare, and occasional severe clinical consequences occur, especially in young children, with both CA-RV and HA-RV gastroenteritis. Appropriate timely intervention and meticulous follow-up improve survival.

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Section: Discussionmentioning

confidence: 50%

Section: Discussionmentioning

confidence: 98%

Clinical Features and Outcomes of Children Admitted to the PICU due to Rotavirus Infection

Gün¹,

Kendirli²,

Öztürk³

et al. 2021

Turk Arch Pediatrics

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Mild encephalitis/encephalopathy with a reversible splenial lesion secondary to encephalitis complicated by hyponatremia

Shi

Li²,

Jiang³

et al. 2019

Medicine

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Rationale: Mild encephalitis/encephalopathy with a reversible splenial lesion (MERS) is an infection-associated encephalitis/encephalopathy syndrome that is predominately caused by a virus. MERS has no direct association with central nervous system (CNS) infections or inflammation. Non-CNS infections may cause reversible lesion in the splenium of corpus callosum. Recently, there have been reports of many patients with hyponatremia related MERS. Interleukin-6 (IL-6) was also found elevated in serum and in cerebrospinal fluid (CSF) in patients with MERS. The role of IL-6 in the non-osmotic release of vasopressin is crucial. Persistent hyponatremia may be linked to this effect. The following is a case report of MERS secondary to encephalitis, complicated by hyponatremia. We will summarize the latest research and progress regarding MERS. Patient concerns: A 31-year-old man was admitted to our department with a 5-day history of fever and headache. His initial diagnosis was encephalitis and hyponatremia; during this period the patient also developed MERS secondary to the encephalitis. Diagnoses: Encephalitis was diagnosed by reviewing the history of fever, headache, neck rigidity and Kerning sign (+) on clinical examination. Lab tests revealed: serum VCA IgG (+), EBNA-1 IgG (−), EBV IgM (−), and inflammation in the analysis of CSF. Cranial MRI+C showed that the blood vessels on the surface of the brain were obviously increasing and thickening and diffuse slow waves were detected on the electroencephalogram (EEG). The patient's hyponatremia aggravated on the third day of hospitalization. On the fourth day of hospitalization, the patient was somnolent, apathetic, and slow. Magnetic resonance imaging (MRI) of the brain, with a T2-weighted fluid attenuated inversion recovery image, showed high-signal intensity in the splenium of the corpus callosum (SCC) on the fifth day of hospitalization. Diffusion-weighted imaging (DWI) showed splenial hyperintensity as a “boomerang sign” and reduced diffusion on apparent diffusion coefficient (ADC) maps. Cranial MRI findings returned to normal after 1 month. The diagnosis of MERS was confirmed. Interventions: We administered an intravenous drip infusion of acyclovir and prescribed oral sodium supplementation. Outcomes: The patient's neurological symptoms gradually improved. The MRI lesion in the SCC disappeared on the 30th day. Lessons: In patients with encephalitis accompanied by hyponatremia, elevated IL-6 or urinary β2-microglobulin (β2MG), and exacerbations such as sudden somnolence, delirium, confusion, and seizures, the possibility of secondary MERS should be investigated, in addition to the progression of encephalitis.

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Apnea and delirious behavior caused by mild encephalitis/encephalopathy with reversible splenial lesion complicated with rotavirus infection

Cited by 2 publications

References 3 publications

Clinical Features and Outcomes of Children Admitted to the PICU due to Rotavirus Infection

Clinical Features and Outcomes of Children Admitted to the PICU due to Rotavirus Infection

Mild encephalitis/encephalopathy with a reversible splenial lesion secondary to encephalitis complicated by hyponatremia

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