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Acute relapsing encephalopathy mimicking acute necrotizing encephalopathy in a 4-year-old boy
K Suwa1, T Yamagata, M Y Momoi
1Department of Pediatrics, Jichi Medical School, Kawachi-gun, Tochigi, Japan. kiyotaka@jichi.ac.jp
Abstract:
A 4-year-old boy showed two episodes of encephalitis/encephalopathy involving disturbed consciousness, convulsion, and paresis associated with the elevated levels of protein and myelin basic protein of the cerebrospinal fluid. MRI studies of the brain revealed symmetrical lesions in the brain stem and thalami at the first episode, and additional lesions were found in the cerebellum involving both the gray and white matter in the second episode. The intensities of MRI lesions were low in T I and high in T2. These episodes were followed by an elevation of the anti-viral antibody titers, for influenza A virus during the first episode and for adenovirus during the second. In the second episode, intravenous methylprednisolone therapy resulted in rapid improvement of his neurological signs.
Insights
A child experienced two episodes of encephalitis/encephalopathy, with neurological symptoms and brain lesions. Viral infections and cerebrospinal fluid abnormalities were noted, with improvement after steroid treatment.
Area of Science:
- Pediatric Neurology
- Neuroimmunology
- Infectious Diseases
Background:
- Encephalitis/encephalopathy presents with neurological dysfunction.
- Cerebrospinal fluid analysis is crucial for diagnosis.
- Magnetic Resonance Imaging (MRI) aids in visualizing brain lesions.
Observation:
- A 4-year-old boy presented with two episodes of encephalitis/encephalopathy.
- Symptoms included disturbed consciousness, convulsions, and paresis.
- Elevated cerebrospinal fluid protein and myelin basic protein were observed.
Findings:
- Brain MRI revealed symmetrical lesions in the brainstem and thalami, later extending to the cerebellum.
- Lesions showed characteristic low T1 and high T2 signal intensities.
- Episodes correlated with elevated antibody titers for Influenza A and Adenovirus.
- Intravenous methylprednisolone therapy led to rapid neurological improvement during the second episode.
Implications:
- This case highlights a potential link between viral infections and demyelinating encephalopathy in children.
- Early diagnosis and prompt immunomodulatory treatment can significantly improve outcomes.
- Further research into the pathogenesis of post-infectious encephalopathy is warranted.