Kawasaki syndrome: Cerebral and cardiovascular complications

Abstract

Kawasaki syndrome (KS) is an acute, febrile illness affecting infants and young children predominantly.' It is characterized by fever, lymphadenitis, mucosal and cutaneous inflammation, and vasculitis.2 Cardiovascular complications are common, reported in up to 55% of patient^.^ Fatalities have been reported in 1-2% of patients. Complications include coronary artery aneurysms, myocardial infarction, cerebral infarction, and widespread aneurysmal disease. A case of KS with coronary and iliac artery aneurysms and cerebral and myocardial infarction is described. CASE REPORTA 6-month-old child arrived in the emergency room with left-sided weakness and focal motor seizures. Previous history was unremarkable except for a febrile illness 3 weeks prior to admission and a second febrile illness with a desquamating rash 5 days before this admission.Cerebral computed tomography (CT) revealed a massive infarction in the distribution of the right middle cerebral artery (Fig. 1). Echocardiography was done to search for a cause for the cerebrovascular accident and revealed a dilated, poorly contractive left ventricle and coronary artery aneurysms (Fig. 2). The patient died suddenly 1 day later.Autopsy revealed aneurysms of the coronary and left internal iliac arteries, myocardial infarction with a left ventricular aneurysm, and the cerebral infarction. All these findings were

Cerebral vasculitis in severe Kawasaki disease: early detection by magnetic resonance imaging and good outcome after intensive treatment

“…In previously published cases, cerebral infarction was either attributed to (1) inflammatory stenosis or occlusion of cervical or intracranial large‐sized vessels, or (2) thromboembolism from hypokinetic myocardium. Thus, classic parenchymal territories corresponding to the arteries of the circle of Willis and internal carotid arteries were involved 6–8 . Autopsies of children with Kawasaki disease revealed cerebral vasculitis affecting medium‐ and small‐sized vessels, with endoarteritis, periarteritis, and perivascular cuffing 4,9 .…”

“…Thus, classic parenchymal territories corresponding to the arteries of the circle of Willis and internal carotid arteries were involved. [6][7][8] Autopsies of children with Kawasaki disease revealed cerebral vasculitis affecting medium-and small-sized vessels, with endoarteritis, periarteritis, and perivascular cuffing. 4,9 Moreover, as a single-photon emission computed tomography study showed, asymptomatic focal hypoperfusion areas in 29% of patients with Kawasaki disease, similar to other inflammatory conditions, suggests a vasculitis mechanism.…”

The Effect of Kawasaki Disease on Cognition and Behavior

“…Both generalized 3,7 and localized [7][8][9][10][11][12][13][14][15] CNS symptoms have been reported in Kawasaki disease. Autopsy findings have shown varying degrees of inflammatory changes in brain vasculature, which are usually less extensive than coronary artery involvement.…”

Ischemic stroke in Kawasaki disease

“…Histopathology on autopsy of some patients with KD indicated cerebrovascular changes, such as endoarteritis, periarteritis, perivascular cuffing, and the focal necrotizing vasculitis . Several cases have been reported of coronary artery aneurysm with stroke, and imaging showed systemic vasculopathy or aneurysm involving the cerebral artery . In the present case, the patient had coronary artery aneurysm with cerebral artery stenosis.…”

“…8 Several cases have been reported of coronary artery aneurysm with stroke, and imaging showed systemic vasculopathy or aneurysm involving the cerebral artery. 9,10 In the present case, the patient had coronary artery aneurysm with cerebral artery stenosis. One could argue whether these two findings were part of the same disease process or were caused by two different diseases, but we consider that KD was the cause of these vascular abnormalities.…”