Junji Azuma1, Shin Nabatame2, Sayaka Nakano2, Yoshiko Iwatani2, Yukihiro Kitai3, Koji Tominaga4, Kuriko Kagitani-Shimono4, Takeshi Okinaga2, Takehisa Yamamoto5, Toshisaburo Nagai6, Keiichi Ozono2. 1. Department of Pediatrics, Osaka University Graduate School of Medicine, Japan; Epilepsy Center, Osaka University Hospital, Japan. Electronic address: jazuma@ped.med.osaka-u.ac.jp. 2. Department of Pediatrics, Osaka University Graduate School of Medicine, Japan; Epilepsy Center, Osaka University Hospital, Japan. 3. Department of Pediatrics, Morinomiya Hospital, Japan. 4. Department of Pediatrics, Osaka University Graduate School of Medicine, Japan; Epilepsy Center, Osaka University Hospital, Japan; United Graduate School of Child Development, Osaka University Graduate School of Medicine, Japan. 5. Department of Pediatrics, Minoh City Hospital, Japan. 6. Division of Health Science, Osaka University Graduate School of Medicine, Japan.
Abstract
OBJECTIVE: To determine the prognostic factors for encephalopathy with bright tree appearance (BTA) in the acute phase through retrospective case evaluation. METHODS: We recruited 10 children with encephalopathy who presented with BTA and classified them into 2 groups. Six patients with evident regression and severe psychomotor developmental delay after encephalopathy were included in the severe group, while the remaining 4 patients with mild mental retardation were included in the mild group. We retrospectively analyzed their clinical symptoms, laboratory data, and magnetic resonance imaging (MRI) and magnetic resonance spectroscopy (MRS) findings. RESULTS: Patients in the severe group developed subsequent complications such as epilepsy and severe motor impairment. Univariate analysis revealed that higher maximum lactate dehydrogenase (LDH) levels (p=0.055) were a weak predictor of poor outcome. Maximum creatinine levels were significantly higher (p<0.05) and minimal platelet counts were significantly lower (p<0.05) in the severe group than in the mild group. Acute renal failure was not observed in any patient throughout the study. MRS of the BTA lesion during the BTA period showed elevated lactate levels in 5 children in the severe group and 1 child in the mild group. MRI performed during the chronic phase revealed severe brain atrophy in all patients in the severe group. CONCLUSIONS: Higher creatinine and LDH levels and lower platelet counts in the acute phase correlated with poor prognosis. Increased lactate levels in the BTA lesion during the BTA period on MRS may predict severe physical and mental disability.
OBJECTIVE: To determine the prognostic factors for encephalopathy with bright tree appearance (BTA) in the acute phase through retrospective case evaluation. METHODS: We recruited 10 children with encephalopathy who presented with BTA and classified them into 2 groups. Six patients with evident regression and severe psychomotor developmental delay after encephalopathy were included in the severe group, while the remaining 4 patients with mild mental retardation were included in the mild group. We retrospectively analyzed their clinical symptoms, laboratory data, and magnetic resonance imaging (MRI) and magnetic resonance spectroscopy (MRS) findings. RESULTS:Patients in the severe group developed subsequent complications such as epilepsy and severe motor impairment. Univariate analysis revealed that higher maximum lactate dehydrogenase (LDH) levels (p=0.055) were a weak predictor of poor outcome. Maximum creatinine levels were significantly higher (p<0.05) and minimal platelet counts were significantly lower (p<0.05) in the severe group than in the mild group. Acute renal failure was not observed in any patient throughout the study. MRS of the BTA lesion during the BTA period showed elevated lactate levels in 5 children in the severe group and 1 child in the mild group. MRI performed during the chronic phase revealed severe brain atrophy in all patients in the severe group. CONCLUSIONS: Higher creatinine and LDH levels and lower platelet counts in the acute phase correlated with poor prognosis. Increased lactate levels in the BTA lesion during the BTA period on MRS may predict severe physical and mental disability.
Keywords:
Acute encephalopathy; Acute encephalopathy with biphasic seizures and late reduced diffusion; Bright tree appearance; Creatinine; Lactate peak; Magnetic resonance spectroscopy; Prognostic factors