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The thalamus and midbrain in Reye syndrome
Stanley D Johnsen1, C Roger Bird
1Section of Child Neurology, Section of Neuroradiology, Barrow Neurological Institute and Children's Health Center, St. Joseph's Hospital, Phoenix, Arizona 85013, USA. s2johnsen@chw.edu
Pediatric Neurology
|May 2, 2006
Summary
This case report details a child with Reye syndrome (RS) who showed early signs of brain impairment on diffusion-weighted MRI. The findings suggest RS may involve restricted water diffusion in the brain, similar to stroke.
Area of Science:
- Pediatric Neurology
- Neuroradiology
- Metabolic Disorders
Background:
- Reye syndrome (RS) is a rare but serious condition affecting children and adolescents, often triggered by viral infections and salicylate use.
- Clinical presentation typically includes vomiting, altered mental status, and liver dysfunction.
- Early diagnosis and management are crucial for patient outcomes.
Observation:
- A previously healthy 5 1/2-year-old male presented with coma and apnea following a viral illness and symptoms of Reye syndrome.
- Initial laboratory findings revealed hypoglycemia, elevated liver enzymes, prolonged clotting times, and hyperammonemia.
- Magnetic resonance imaging (MRI) demonstrated restricted diffusion in the thalamus and midbrain on modified diffusion-weighted imaging (DWI).
Findings:
- The patient exhibited clinical and biochemical features consistent with Reye syndrome.
- Diffusion-weighted MRI revealed early signs of cytotoxic edema in the thalamus and midbrain, characterized by restricted water diffusion.
- These DWI findings, typically associated with ischemic stroke, represent a novel observation in the context of Reye syndrome.
Implications:
- This case highlights the potential utility of DWI in detecting early brain involvement in Reye syndrome.
- The findings suggest that impaired water diffusion may be an early pathophysiological mechanism in RS affecting specific brain regions.
- Further research is warranted to explore the significance of DWI abnormalities in Reye syndrome and their correlation with clinical severity and prognosis.