The Clinical and Imaging Characteristics Associated With Neurological Sequelae of Pediatric Patients With Acute Necrotizing Encephalopathy
Open Access
- 11 May 2021
- journal article
- research article
- Published by Frontiers Media SA in Frontiers in Pediatrics
Abstract
Background: Acute necrotizing encephalopathy of childhood (ANE) is a rare but rapidly progressing encephalopathy. Importantly, the exact pathogenesis and evidence-based treatment is scarce. Thus, we aimed to identify the clinical, imaging, and therapeutic characteristics that associated with prognosis of pediatric ANE patients. Methods: A retrospective study was conducted on pediatric patients with ANE who were admitted to Wuhan Children's Hospital between January 2014 and September 2019. All cases met the diagnostic criteria for ANE proposed by Mizuguchi in 1997. The clinical information and follow-up data were collected. The prognostic factors were analyzed by trend chi-square test and Goodman–Kruskal gamma test. Results: A total of 41 ANE patients ranging in age from 8.9 to 142 months were included in this study. Seven cases (17%) died, and the other 34 survivors had different degrees of neurological sequelae. Factors tested to be significantly correlated with the severity of neurological sequelae were the intervals from prodromal infection to acute encephalopathy (G = −0.553), conscious disturbance (r = 0.58), endotracheal intubation (r = 0.423), elevation of alanine aminotransferase (r = 0.345), aspartate aminotransferase (r = 0.393), and cerebrospinal fluid protein (r = 0.490). In addition, dynamic magnetic resonance imaging (MRI) evaluation on follow-up revealed that the total numbers of brain lesion location (χ2 = 6.29, P < 0.05), hemorrhage (r = 0.580), cavitation (r = 0.410), and atrophy (r = 0.602) status were significantly correlated with the severity of neurological sequelae, while early steroid therapy (r = −0.127 and 0.212, respectively) and intravenous immunoglobulin (IVIG) (r = 0.111 and −0.023, respectively) within 24 h or within 72 h after onset showed no association. Conclusions: Intervals from prodromal infection to acute encephalopathy (≤1 day), total numbers of brain lesion location (≥3), the recovery duration of hemorrhage and atrophy (>3 months), and the presence of cavitation predict severe neurological sequelae in pediatric patients with ANE. Early treatments, including steroid therapy and IVIG, had no correlation with better outcomes. Further studies are needed to establish a consensus guideline for the management of ANE.This publication has 17 references indexed in Scilit:
- Acute Necrotizing Encephalopathy of Childhood: A Multicenter Experience in Saudi ArabiaFrontiers in Pediatrics, 2020
- [Advances in clinical and imaging studies of acute necrotizing encephalopathy].2017
- Acute Necrotizing Encephalopathy: An Underrecognized Clinicoradiologic DisorderMediators of Inflammation, 2015
- A severity score for acute necrotizing encephalopathyBrain & Development, 2014
- Clinical Spectrum and Prognostic Factors of Acute Necrotizing Encephalopathy in ChildrenJournal of Korean Medical Science, 2010
- Outcome of acute necrotizing encephalopathy in relation to treatment with corticosteroids and gammaglobulinBrain & Development, 2009
- Acute Necrotizing Encephalopathy of Childhood: Correlation of MR Findings and Clinical Outcome2006
- Acute necrotizing encephalopathy of childhood with radiographic progression over 10 hoursNeurology, 2003
- Acute necrotizing encephalopathy of childhood: a novel form of acute encephalopathy prevalent in Japan and TaiwanBrain & Development, 1997
- Acute necrotising encephalopathy of childhood: a new syndrome presenting with multifocal, symmetric brain lesions.Journal of Neurology, Neurosurgery & Psychiatry, 1995