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Recognition and early management of Reye's syndrome
Insights
Reye
Area of Science:
- Pediatrics
- Neurology
Background:
- Reye's syndrome presents a significant mortality risk.
- Early diagnosis and prompt intensive care are critical for Reye's syndrome outcomes.
Purpose of the Study:
- To evaluate outcomes and identify prognostic factors for Reye's syndrome in a pediatric intensive care unit.
- To assess the diagnostic utility of clinical signs and investigations in Reye's syndrome management.
Main Methods:
- Retrospective analysis of 12 Reye's syndrome cases admitted to a pediatric intensive care unit over four years.
- Evaluation of clinical progression, laboratory findings (peak ammonia), diagnostic procedures (lumbar puncture, CT scan), and patient outcomes.
Main Results:
- Seven of 12 patients died; outcomes varied from normal to severe cerebral damage.
- High peak ammonia levels and rapid coma progression correlated with poor prognosis.
- Delayed referral to the intensive care unit was associated with adverse outcomes.
- Lumbar puncture preceded neurological deterioration in six children; papilledema was absent in all cases.
- Computed tomography (CT) provided supportive evidence of raised intracranial pressure, but direct measurement was definitive.
Conclusions:
- Prompt admission to a pediatric intensive care unit is crucial for managing Reye's syndrome.
- Deferring lumbar puncture in rapidly progressing coma until intracranial pressure is assessed is recommended.
- Early CT and intracranial pressure monitoring facilities are vital for optimal Reye's syndrome care.
Abstract:
Reye's syndrome continues to be associated with a high mortality. Out of 12 cases treated on our intensive care unit over a four year period, seven died, one suffered minimal cerebral damage, and four were normal. Rapid progression through coma stages and high peak ammonia concentrations worsened prognosis. Reye's syndrome was suspected in only 50% of cases at the referring hospital and resulted in prompt referral to the intensive care unit in only one case. Late referral to the unit was associated with a poor outcome. Sudden neurological deterioration followed diagnostic lumbar puncture in six children. Papilloedema was an unreliable sign of raised intracranial pressure and was absent in all cases. While computed tomography of the brain was useful in providing additional evidence of raised intracranial pressure, this could only be confirmed by direct measurement. Lumbar puncture in the presence of rapidly progressive coma should be deferred until raised intracranial pressure has been excluded. To this end, early admission to a paediatric intensive care unit with facilities for computed tomography and monitoring of intracranial pressure is recommended.