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Systemic inflammatory response syndrome and prolonged hypoperfusion lesions in an infant with respiratory syncytial virus encephalopathy.

Miyamoto K, Fujisawa M, Hozumi H, Tsuboi T, Kuwashima S, Hirao J, Sugita K, Arisaka O - J. Infect. Chemother. (2013)

Bottom Line: On day 14, the patient presented with delayed partial seizure and an electroencephalogram showed occasional unilateral spikes in the parietal area, but the hippocampal abnormality had improved to normal on MRI. (99m)Tc-labeled ethylcysteinate dimer single-photon emission computed tomography (SPECT) on day 18 showed hypoperfusion of the bilateral frontal and parietal regions and the unilateral temporal region.SPECT at 3 months after onset still showed hypoperfusion of the bilateral frontal region and unilateral temporal region, but hypoperfusion of the bilateral parietal region had improved.The patient has no neurological deficit at 6 months.

View Article: PubMed Central - PubMed

Affiliation: Department of Pediatrics, Dokkyo Medical University, 880 Kitakobayashi, Mibu-machi, Shimotsuga, Tochigi, 321-0293, Japan, kenmimi@dokkyomed.ac.jp.

ABSTRACT
Respiratory syncytial virus (RSV) is a cause of neurological complications in infants. We report a rare case of RSV encephalopathy in an infant who presented with poor sucking and hypothermia at 17 days of age after suffering from rhinorrhea and a cough for several days. After hospitalization, the patient presented with stupor and hypotonia lasting for at least 24 h, and was intubated, sedated, and ventilated for treatment of pneumonia. These symptoms led to diagnosis of pediatric systemic inflammatory response syndrome (SIRS) caused by RSV infection. High-dose steroid therapy was combined with artificial ventilation because the initial ventilation therapy was ineffective. Interleukin (IL)-6 levels in spinal fluid were markedly increased upon admission, and serum IL-6 and IL-8 levels showed even greater elevation. The patient was diagnosed with RSV encephalopathy. On day 5, high signal intensity in the bilateral hippocampus was observed on diffusion-weighted magnetic resonance imaging (MRI). On day 14, the patient presented with delayed partial seizure and an electroencephalogram showed occasional unilateral spikes in the parietal area, but the hippocampal abnormality had improved to normal on MRI. (99m)Tc-labeled ethylcysteinate dimer single-photon emission computed tomography (SPECT) on day 18 showed hypoperfusion of the bilateral frontal and parietal regions and the unilateral temporal region. SPECT at 3 months after onset still showed hypoperfusion of the bilateral frontal region and unilateral temporal region, but hypoperfusion of the bilateral parietal region had improved. The patient has no neurological deficit at 6 months. These findings suggest that RSV encephalopathy with cytokine storm induces several symptoms and complications, including SIRS and prolonged brain hypoperfusion on SPECT.

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Magnetic resonance imaging (MRI) on day 6. Diffusion-weighted imaging (DWI) (a) revealed bilateral high-intensity regions in the hippocampus, and the apparent diffusion coefficient (ADC) (b) was low in the same regions. c–f99mTc- ethylcysteinate dimer (ECD) single-photon emission computed tomography (SPECT). Axial views through the parietal lobes (c, e) and through the cerebral cortex, white matter, and basal ganglia (d, f). Upper row (c, d): At 18 days after onset (hospital day 18), SPECT showed hypoperfusion of the bilateral frontal and parietal lobes and the unilateral temporal lobe with some predominance on the left side. Lower row (e, f): At 3 months after onset, hypoperfusion of the bilateral parietal lobes on SPECT had improved, but hypoperfusion of the unilateral temporal lobe with some predominance on the left side was exacerbated
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Fig1: Magnetic resonance imaging (MRI) on day 6. Diffusion-weighted imaging (DWI) (a) revealed bilateral high-intensity regions in the hippocampus, and the apparent diffusion coefficient (ADC) (b) was low in the same regions. c–f99mTc- ethylcysteinate dimer (ECD) single-photon emission computed tomography (SPECT). Axial views through the parietal lobes (c, e) and through the cerebral cortex, white matter, and basal ganglia (d, f). Upper row (c, d): At 18 days after onset (hospital day 18), SPECT showed hypoperfusion of the bilateral frontal and parietal lobes and the unilateral temporal lobe with some predominance on the left side. Lower row (e, f): At 3 months after onset, hypoperfusion of the bilateral parietal lobes on SPECT had improved, but hypoperfusion of the unilateral temporal lobe with some predominance on the left side was exacerbated

Mentions: The patient was intubated and ventilated immediately. Profound sedation was used because high-pressure mechanical ventilation was required. Immunomodulatory therapy with high-dose steroids (methylprednisolone 30 mg/kg/day for 3 days) was also initiated because the respiratory therapies were ineffective. On day 5, there were no significant abnormalities on T1-weighted, T2-weighted, and fluid-attenuated inversion recovery magnetic resonance imaging (MRI), but the bilateral hippocampus showed a high signal intensity in diffusion-weighted imaging (DWI) MRI with reduction of the apparent diffusion coefficient (ADC) (Fig. 1 a, b). An electroencephalogram (EEG) was normal on day 5. The patient was extubated on day 7.Fig. 1


Systemic inflammatory response syndrome and prolonged hypoperfusion lesions in an infant with respiratory syncytial virus encephalopathy.

Miyamoto K, Fujisawa M, Hozumi H, Tsuboi T, Kuwashima S, Hirao J, Sugita K, Arisaka O - J. Infect. Chemother. (2013)

Magnetic resonance imaging (MRI) on day 6. Diffusion-weighted imaging (DWI) (a) revealed bilateral high-intensity regions in the hippocampus, and the apparent diffusion coefficient (ADC) (b) was low in the same regions. c–f99mTc- ethylcysteinate dimer (ECD) single-photon emission computed tomography (SPECT). Axial views through the parietal lobes (c, e) and through the cerebral cortex, white matter, and basal ganglia (d, f). Upper row (c, d): At 18 days after onset (hospital day 18), SPECT showed hypoperfusion of the bilateral frontal and parietal lobes and the unilateral temporal lobe with some predominance on the left side. Lower row (e, f): At 3 months after onset, hypoperfusion of the bilateral parietal lobes on SPECT had improved, but hypoperfusion of the unilateral temporal lobe with some predominance on the left side was exacerbated
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3824296&req=5

Fig1: Magnetic resonance imaging (MRI) on day 6. Diffusion-weighted imaging (DWI) (a) revealed bilateral high-intensity regions in the hippocampus, and the apparent diffusion coefficient (ADC) (b) was low in the same regions. c–f99mTc- ethylcysteinate dimer (ECD) single-photon emission computed tomography (SPECT). Axial views through the parietal lobes (c, e) and through the cerebral cortex, white matter, and basal ganglia (d, f). Upper row (c, d): At 18 days after onset (hospital day 18), SPECT showed hypoperfusion of the bilateral frontal and parietal lobes and the unilateral temporal lobe with some predominance on the left side. Lower row (e, f): At 3 months after onset, hypoperfusion of the bilateral parietal lobes on SPECT had improved, but hypoperfusion of the unilateral temporal lobe with some predominance on the left side was exacerbated
Mentions: The patient was intubated and ventilated immediately. Profound sedation was used because high-pressure mechanical ventilation was required. Immunomodulatory therapy with high-dose steroids (methylprednisolone 30 mg/kg/day for 3 days) was also initiated because the respiratory therapies were ineffective. On day 5, there were no significant abnormalities on T1-weighted, T2-weighted, and fluid-attenuated inversion recovery magnetic resonance imaging (MRI), but the bilateral hippocampus showed a high signal intensity in diffusion-weighted imaging (DWI) MRI with reduction of the apparent diffusion coefficient (ADC) (Fig. 1 a, b). An electroencephalogram (EEG) was normal on day 5. The patient was extubated on day 7.Fig. 1

Bottom Line: On day 14, the patient presented with delayed partial seizure and an electroencephalogram showed occasional unilateral spikes in the parietal area, but the hippocampal abnormality had improved to normal on MRI. (99m)Tc-labeled ethylcysteinate dimer single-photon emission computed tomography (SPECT) on day 18 showed hypoperfusion of the bilateral frontal and parietal regions and the unilateral temporal region.SPECT at 3 months after onset still showed hypoperfusion of the bilateral frontal region and unilateral temporal region, but hypoperfusion of the bilateral parietal region had improved.The patient has no neurological deficit at 6 months.

View Article: PubMed Central - PubMed

Affiliation: Department of Pediatrics, Dokkyo Medical University, 880 Kitakobayashi, Mibu-machi, Shimotsuga, Tochigi, 321-0293, Japan, kenmimi@dokkyomed.ac.jp.

ABSTRACT
Respiratory syncytial virus (RSV) is a cause of neurological complications in infants. We report a rare case of RSV encephalopathy in an infant who presented with poor sucking and hypothermia at 17 days of age after suffering from rhinorrhea and a cough for several days. After hospitalization, the patient presented with stupor and hypotonia lasting for at least 24 h, and was intubated, sedated, and ventilated for treatment of pneumonia. These symptoms led to diagnosis of pediatric systemic inflammatory response syndrome (SIRS) caused by RSV infection. High-dose steroid therapy was combined with artificial ventilation because the initial ventilation therapy was ineffective. Interleukin (IL)-6 levels in spinal fluid were markedly increased upon admission, and serum IL-6 and IL-8 levels showed even greater elevation. The patient was diagnosed with RSV encephalopathy. On day 5, high signal intensity in the bilateral hippocampus was observed on diffusion-weighted magnetic resonance imaging (MRI). On day 14, the patient presented with delayed partial seizure and an electroencephalogram showed occasional unilateral spikes in the parietal area, but the hippocampal abnormality had improved to normal on MRI. (99m)Tc-labeled ethylcysteinate dimer single-photon emission computed tomography (SPECT) on day 18 showed hypoperfusion of the bilateral frontal and parietal regions and the unilateral temporal region. SPECT at 3 months after onset still showed hypoperfusion of the bilateral frontal region and unilateral temporal region, but hypoperfusion of the bilateral parietal region had improved. The patient has no neurological deficit at 6 months. These findings suggest that RSV encephalopathy with cytokine storm induces several symptoms and complications, including SIRS and prolonged brain hypoperfusion on SPECT.

Show MeSH
Related in: MedlinePlus