Clinical-imaging features and prognoses of 8 children with acute encephalopathy combined with biphasic seizures and late reduced diffusion / 中华神经医学杂志

ABSTRACT

Objective:To summarize the clinical-imaging features and prognoses of acute encephalopathy combined with biphasic seizures and late reduced diffusion (AESD).Methods:A retrospective analysis was performed. The clinical and imaging data and follow-up results of 8 children with AESD, admitted to Departments of Neurology and Rehabilitation Medicine, Wuhan Children's Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology from January 2020 to April 2022 were collected.Results:The antecedent infections in 8 children were predominantly gastrointestinal and respiratory tract infections and convulsive seizures occured within 24 h of fever. The clinical presentation was biphasic: 3 had sustained convulsive state in the first phase of the disease, and all showed cluster seizures with worsening impairment of consciousness in the second phase of the disease, including 4 with involuntary movements during recovery from the disease. Seven children required admission to Intensive Care Unit, 4 required tracheal intubation for assisted ventilation, and 1 was combined with septic shock. Brain MRI findings of 8 children were "bright tree" in the second phase of the disease, including bilateral symmetrical and bilateral asymmetrical involvements, with diffuse and focal involvements. All 8 children were treated with glucocorticoids and/or gammaglobulin, and 2 were given mild hypothermia brain protection. Follow-up was performed for more than 3 months, and brain MRI indicated cerebral atrophy, subdural effusion and cerebral malacia. All the 8 children survived with different degrees of sequelae. Two children had Extended Glasgow Outcome Scale scores of 4, 4 had scores of 5, and 2 had scores of 7.Conclusion:AESD is a special clinical-maging syndrome, characterized by biphasic seizure and "bright tree" on head MRI; the survival is high, but neurological sequelae of different degrees are easily left behind.