Excellent Outcome of Acute Necrotizing Encephalopathy in an Adult With Bacterial Infections, Case Report

2021 ◽  
pp. 194187442199137
Author(s):  
Yan Wang ◽  
John R. Younce ◽  
Joel S. Perlmutter ◽  
Soe S. Mar
Keyword(s):  
Differential Diagnosis ◽  
Bacterial Infections ◽  
Vasogenic Edema ◽  
Brain Magnetic Resonance Imaging ◽  
Acute Necrotizing Encephalopathy ◽  
Excellent Outcome ◽  
Intravenous Antibiotics ◽  
Acute Necrotizing ◽  
Supportive Management

Acute necrotizing encephalopathy (ANE) is a rare para-infectious encephalopathy that classically occurs in children. However, ANE should be considered in the differential diagnosis of adults with symmetric brain lesions after a prodromal illness given recent reports of coronavirus disease of 2019 (COVID-19) to presumably cause ANE in adults. We report a case of a 29-year-old male presenting with fever, malaise, and rapid deterioration into coma. Brain magnetic resonance imaging revealed multifocal symmetric areas of diffusion restriction and surrounding vasogenic edema involving bilateral thalami, pons and cerebellar hemispheres with a core of susceptibility artifact, and minimal thalamic contrast enhancement, most consistent with ANE. Extensive infectious workup revealed isolated Escherichia coli and Neisseria gonorrhoeae in his urine. Despite the severe encephalopathy on initial presentation, the patient improved with intravenous antibiotics and supportive management with minimal residual deficits at 9 months follow-up. We aim to provide an overview of the radiological features, differential diagnosis, treatment and prognosis of ANE. Becoming familiarized with this rare but devastating disease will improve detection, treatment, and ultimately prognosis, especially in the era of a new pandemic.

scholarly journals Only a Touch of the Flu? The Simultaneous Manifestation of Acute Necrotizing Encephalopathy in Two Consanguineous Patients

2015 ◽  
Vol 2 (2) ◽  
Author(s):  
C. Bloch ◽  
B. Suter ◽  
A. Fischmann ◽  
H. Gensicke ◽  
S. Rüegg ◽  
...  
Keyword(s):  
Differential Diagnosis ◽  
Case Report ◽  
Missense Mutation ◽  
Autosomal Dominant ◽  
Treatment Strategies ◽  
Influenza B ◽  
Acute Encephalopathy ◽  
Acute Necrotizing Encephalopathy ◽  
Acute Necrotizing

Abstract This case report describes the simultaneous manifestation of acute necrotizing encephalopathy in 2 consanguineous patients after infection with influenza B based on the autosomal dominant missense mutation of the RANBP2-gene. Differential diagnosis of acute encephalopathy, clinical and radiological clues, and treatment strategies are outlined.

scholarly journals The Clinical and Imaging Characteristics Associated With Neurological Sequelae of Pediatric Patients With Acute Necrotizing Encephalopathy

2021 ◽  
Vol 9 ◽  
Author(s):  
Hong-Min Zhu ◽  
Si-Min Zhang ◽  
Cong Yao ◽  
Meng-Qing Luo ◽  
Hui-Jing Ma ◽  
...  
Keyword(s):  
Steroid Therapy ◽  
Pediatric Patients ◽  
Brain Lesion ◽  
Acute Encephalopathy ◽  
Neurological Sequelae ◽  
Acute Necrotizing Encephalopathy ◽  
Lesion Location ◽  
Imaging Characteristics ◽  
Acute Necrotizing

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.

Brain magnetic resonance imaging of an adult case of acute necrotizing encephalopathy

2007 ◽  
Vol 254 (8) ◽  
pp. 1135-1137 ◽  
Author(s):  
Haruhisa Kato ◽  
Hideo Hasegawa ◽  
Mutsumi Iijima ◽  
Masanobu Uchigata ◽  
Taizo Terada ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Brain Magnetic Resonance Imaging ◽  
Resonance Imaging ◽  
Adult Case ◽  
Acute Necrotizing Encephalopathy ◽  
Acute Necrotizing

Treatment Timing, EEG, Neuroimaging, and Outcomes After Acute Necrotizing Encephalopathy in Children

2021 ◽  
pp. 088307382098406
Author(s):  
Brian Appavu ◽  
Stephen Foldes ◽  
Jordana Fox ◽  
Sheetal Shetty ◽  
Ann Oh ◽  
...  
Keyword(s):  
Brain Magnetic Resonance Imaging ◽  
Rare Condition ◽  
Patient Characteristics ◽  
Immunomodulatory Therapy ◽  
Sleep Spindles ◽  
Rapid Progression ◽  
Acute Necrotizing Encephalopathy ◽  
Severity Scores ◽  
Acute Necrotizing ◽  
Length Of Hospitalization

Background: Acute necrotizing encephalopathy (ANE) is a rare condition associated with rapid progression to coma and high incidence of morbidity and mortality. Methods: Clinical, electroencephalographic (EEG), and brain magnetic resonance imaging (MRI) characteristics and immunomodulatory therapy timing were retrospectively analyzed in children with ANE. ANE severity scores (ANE-SS) and MRI scores were also assessed. The associations of patient characteristics with 6-month modified Rankin scale (mRS) and length of hospitalization were determined using either univariate linear regression or one-way analysis of variance. Results: 7 children were retrospectively evaluated. Normal EEG sleep spindles ( P = .024) and early treatment ( R 2 = .57, P = .030) were associated with improved outcomes (ie, decreased mRS). Higher ANE-SS ( R 2 = .79, P = .011), higher age ( R 2 = .62, P = .038), and presence of brainstem lesions ( P = .015) were associated with longer length of hospitalization. Other patient characteristics were not significantly associated with mRS or length of hospitalization. Conclusion: Early immunomodulatory therapy and normal sleep spindles are associated with better functional outcome in children with ANE.

scholarly journals Acute necrotizing encephalopathy causing human bocavirus

2017 ◽  
Vol 30 (2) ◽  
pp. 164-167 ◽  
Author(s):  
Ayse Betul Ergul ◽  
Umit Altug ◽  
Kursad Aydin ◽  
Ahmet Sami Guven ◽  
Yasemin Altuner Torun
Keyword(s):  
Brain Magnetic Resonance Imaging ◽  
Influenza Viruses ◽  
Human Bocavirus ◽  
Hypertonic Saline Solution ◽  
Caudate Nuclei ◽  
Acute Necrotizing Encephalopathy ◽  
First Case ◽  
Ammonium Lactate ◽  
Acute Necrotizing ◽  
Tract Infections

Acute necrotizing encephalopathy is characterized by multiple, symmetrical lesions involving the thalamus, brainstem, cerebellum, and white matter and develops secondarily to viral infections. Influenza viruses are the most common etiological agents. Here, we present the first case of acute necrotizing encephalopathy to develop secondarily to human bocavirus. A 3-year-old girl presented with fever and altered mental status. She had had a fever, cough, and rhinorrhea for five days. The patient was admitted to the intensive care unit with an initial diagnosis of encephalitis when vomiting, convulsions, and loss of consciousness developed. Signs of meningeal irritation were detected upon physical examination. There was a mild increase in proteins, but no cells, in the cerebrospinal fluid (CSF). Brain magnetic resonance imaging showed symmetrical, heterogeneous hyperintensities bilaterally in the caudate nuclei and putamen. Ammonium, lactate, tandem mass spectroscopy, and urine organic acid were normal. No bacteria were detected in the CSF cultures. Human bocavirus was detected in a nasopharyngeal aspirate using real-time PCR, while no influenza was detected. Oseltamivir, acyclovir, 3% hypertonic saline solution, and supportive care were used to treat the patient, who was discharged after two weeks. She began to walk and talk after one month of physical therapy and complete recovery was observed after six months. Human bocavirus is a recently identified virus that is mainly reported as a causative agent in respiratory tract infections. Here, we present a case of influenza-like acute necrotizing encephalopathy secondary to human bocavirus infection.

scholarly journals Primary breast tuberculosis: imaging findings of a rare disease

2021 ◽  
Vol 12 (1) ◽  
Author(s):  
Ali H. Baykan ◽  
Hakan S. Sayiner ◽  
Ibrahim Inan ◽  
Elcin Aydin ◽  
Sukru M. Erturk
Keyword(s):  
Differential Diagnosis ◽  
Rare Disease ◽  
Extrapulmonary Tuberculosis ◽  
Reproductive Age ◽  
Malignant Diseases ◽  
Imaging Findings ◽  
Granulomatous Mastitis ◽  
Rare Form ◽  
Breast Tuberculosis

AbstractBreast tuberculosis is a rare form of extrapulmonary tuberculosis which tends to affect females of reproductive age, and is much rarer in males, postmenopausal women, and pre-pubescent girls. It is difficult to diagnose because it can mimic benign conditions such as a fibroadenoma, as well as malignant diseases like a carcinoma. It is also particularly difficult to distinguish breast tuberculosis from granulomatous mastitis, so other possible diagnoses should be ruled out first. The diagnosis of breast tuberculosis has three essential pillars: clinical examination, radiological evaluations, and histopathological sampling. Radiological evaluations are not only critical in diagnosis but are also important in the planning of the treatment and during the follow-up. This paper aims to review the imaging findings and the differential diagnosis of breast tuberculosis.

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