Diagnostic and prognostic factors for acute encephalopathy

Motojima, Yukiko; Nagura, Michiaki; Asano, Yoshitaka; Arakawa, Hiroshi; Takada, Eiko; Sakurai, Yoshio; Moriwaki, Koichi; Tamura, Masanori

doi:10.1111/ped.12995

Cited by 11 publications

(12 citation statements)

References 10 publications

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“…Elevated LDH is a consequence of tissue damage (Augoff et al 2015) and has been observed in various pathologies, such as encephalitis, ischemic stroke or head injuries (Valvona et al 2016). Moreover, LDH levels have also been correlated with acute encephalopathy and could be related to prognosis as a significant difference in serum LDH levels was observed between pediatrics patients with and without developmental regression following acute encephalopathy (Motojima et al 2016). Future research should evaluate if this association between serum LDH levels and DTI metrics in COVID-19 patients is related to neurological complications, such as encephalopathy, and if it is the case, whether it is a good predictor of outcome regarding neurological sequelae.…”

Section: Discussionmentioning

confidence: 99%

C-reactive protein and white matter microstructural changes in COVID-19 patients with encephalopathy

et al. 2021

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Encephalopathy is a neurological complication of COVID-19. The objective of this exploratory study is to investigate the link between systemic inflammation and brain microstructural changes (measured by diffusion-weighted imaging) in patients with COVID-19 encephalopathy. 20 patients with COVID-19 encephalopathy (age: 67.3 $$\pm$$ ± 10.0 years; 90% men) hospitalized in the Geneva University Hospitals for a SARS-CoV-2 infection between March and May 2020 were included in this retrospective cohort study. COVID-19 encephalopathy was diagnosed following a comprehensive neurobiological evaluation, excluding common causes of delirium, such as hypoxemic or metabolic encephalopathy. We investigated the correlation between systemic inflammation (measured by systemic C-reactive protein (CRP)) and brain microstructural changes in radiologically normal white matter (measured by apparent diffusion coefficient (ADC)) in nine spatially widespread regions of the white matter previously associated with delirium. Systemic inflammation (CRP = 60.8 ± 50.0 mg/L) was positively correlated with ADC values in the anterior corona radiata (p = 0.0089), genu of the corpus callosum (p = 0.0064) and external capsule (p = 0.0086) after adjusting for patients’ age. No statistically significant association between CRP and ADC was found in the other six white matter regions. Our findings indicate high risk of white matter abnormalities in COVID-19 encephalopathy patients with high peripheral inflammatory markers, suggesting aggressive imaging monitoring may be warranted in these patients. Future studies should clarify a possible specificity of the spatial patterns of CRP–white matter microstructure association in COVID-19 encephalopathy patients and disentangle the role of individual cytokines on brain inflammatory mechanisms.

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Section: Discussionmentioning

confidence: 99%

C-reactive protein and white matter microstructural changes in COVID-19 patients with encephalopathy

et al. 2021

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“…For the multivariate logistic regression analysis, it was necessary to remove the strongly correlated parameters. Since AST is reportedly a predictor of poor outcome in patients with AE and status epilepticus [15,[20][21][22], we selected the AST level as a reference parameter for blood tests and examined the correlations between the AST level and the other significant parameters. The serum ALT, LDH, CK, and Cre levels were positively associated with the AST level (i.e., the correlation coefficient between the AST and ALT levels was 0.839, p < 0.001; Supplemental Figure 1).…”

Section: Resultsmentioning

confidence: 99%

Predicting the outcomes of targeted temperature management for children with seizures and/or impaired consciousness accompanied by fever without known etiology

Tanaka

Nagase

Yamaguchi

et al. 2019

Brain and Development

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BACKGROUND: Seizures and/or impaired consciousness accompanied by fever without known etiology (SICF) is common in the pediatric emergency setting. No optimal strategy for the management of SICF in childhood currently exists. We previously demonstrated the effectiveness of targeted temperature management (TTM) against SICF with a high risk of morbidity; however, some patients with SICF develop neurological sequelae despite TTM, which necessitate additional neuroprotective treatment. The clinical characteristics of these severe cases have not been studied. Accordingly, the aim of this study was to identify the clinical characteristics of children with SICF who exhibit poor outcomes after TTM. METHODS: The medical records of children admitted to Kobe Children's Hospital (Kobe, Japan) between October 2002 and September 2016 were retrospectively reviewed. Patients with SICF treated using TTM were included and divided into the satisfactory and poor outcome groups. Univariate and multivariate logistic regression analyses were used to compare clinical characteristics and laboratory findings between the two groups. RESULTS: Of the 73 included children, 10 exhibited poor outcomes. Univariate logistic regression analysis revealed that acute circulatory failure before TTM initiation, the use of four or more types of anticonvulsants, methylprednisolone pulse therapy, and an aspartate aminotransferase (AST) level ≥73 IU/L were associated with poor outcomes. Multivariate logistic regression analysis identified an elevated AST level as a significant independent predictor of a poor outcome. CONCLUSIONS: An elevated AST level within 12 h of onset in children with SICF is an independent predictor of a poor outcome after TTM initiated within 24 h of onset.

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“…They suggested that age less than 1.5 years and a Glasgow Coma Scale score of 14 or less (Japan Coma Scale score of 1 or higher) were high risk factors for developing acute encephalopathy with biphasic seizures and late reduced diffusion 7 . Another report described significant differences between febrile seizures and acute encephalopathy in terms of serum liver enzyme levels 8 . In regard to the early seizure phase, there are no reports that differentiate between non-prolonged febrile seizures and acute encephalopathy.…”

Section: Discussionmentioning

confidence: 99%

A Case of Acute Encephalopathy Associated with Acute Focal Bacterial Nephritis

2022

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Acute encephalopathy is a syndrome characterized by an acute onset of disturbance of consciousness. Many acute encephalopathies are caused by viral infections; however, they can also be a result of bacterial infections. Acute focal bacterial nephritis (AFBN) can cause neurological symptoms, such as irritation, unconsciousness, and seizures. In some cases, AFBN-associated acute encephalopathy has also been reported. This report describes the first case of acute encephalopathy without the characteristic findings of MRI-associated AFBN. The patient was a 3-year-old male, who had febrile seizure at the ages of 1 and 2 years. He developed disturbance of consciousness, irritability, excitability, and neck stiffness on the day after admission. There were no abnormal findings on brain MRI; however, a generalized high-voltage slow wave was noted on electroencephalography (EEG). His urinary sediment count was elevated, and Morganella morganii and Enterococcus faecalis were detected in the urinary culture. A diagnosis of acute encephalopathy with urinary tract infection (UTI) was made.

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Diagnostic and prognostic factors for acute encephalopathy

Abstract: Serum AST, ALT and LDH may be related to early diagnosis and prognosis, and should be carefully investigated in patients with encephalopathy. CSF tau protein could also be used as an indicator of poor prognosis in acute encephalopathy.

Cited by 11 publications

References 10 publications

C-reactive protein and white matter microstructural changes in COVID-19 patients with encephalopathy

C-reactive protein and white matter microstructural changes in COVID-19 patients with encephalopathy

Predicting the outcomes of targeted temperature management for children with seizures and/or impaired consciousness accompanied by fever without known etiology

A Case of Acute Encephalopathy Associated with Acute Focal Bacterial Nephritis

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