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Acute encephalopathy associated with influenza and other viral infections

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Mizuguchi M, Yamanouchi H, Ichiyama T, Shiomi M. Acute encephalopathy associated with influenza and other viral infections.

Acta Neurol Scand 2007: 115 (Suppl. 186): 45–56. © 2007 The Authors Journal compilation © 2007 Blackwell Munksgaard.

Acute encephalopathy is the most serious complication of pediatric viral infections, such as influenza and exanthem subitum. It occurs worldwide, but is most prevalent in East Asia, and every year several hundreds of Japanese children are affected by influenza-associated encephalopathy. Mortality has recently declined, but is still high. Many survivors are left with motor and intellectual disabilities, and some with epilepsy. This article reviews various syndromes of acute encephalopathy by classifying them into three major categories. The first group caused by metabolic derangement consists of various inherited metabolic disorders and the classical Reye syndrome. Salicylate is a risk factor of the latter condition. The second group, characterized by a systemic cytokine storm and vasogenic brain edema, includes Reye-like syndrome, hemorrhagic shock and encephalopathy syndrome, and acute necrotizing encephalopathy. Non-steroidal anti-inflammatory drugs, such as diclofenac sodium and mephenamic acid, may aggravate these syndromes. Severe cases are complicated by multiple organ failure and disseminated intravascular coagulation. Mortality is high, although methylprednisolone pulse therapy may be beneficial in some cases. The third group, characterized by localized edema of the cerebral cortex, has recently been termed acute encephalopathy with febrile convulsive status epilepticus, and includes hemiconvulsion-hemiplegia syndrome and acute infantile encephalopathy predominantly affecting the frontal lobes. Theophylline is a risk factor of these syndromes. The pathogenesis is yet to be clarified, but an increasing body of evidence points to excitotoxicity and delayed neuronal death.
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Keywords: Reye-like syndrome; acute encephalopathy; acute encephalopathy with febrile convulsive status epilepticus; acute infantile encephalopathy predominantly affecting the frontal lobes; acute necrotizing encephalopathy; hemiconvulsion-hemiplegia syndrome; hemorrhagic shock and encephalopathy syndrome

Document Type: Research Article

Affiliations: 1: Department of Pediatrics, Graduate School of Medicine, University of Tokyo, Tokyo, Japan 2: Department of Pediatrics, Dokkyo University School of Medicine, Mibu, Japan 3: Department of Pediatrics, Yamaguchi University School of Medicine, Ube, Japan 4: Department of Pediatric Emergency Medicine, Osaka City General Hospital, Osaka, Japan

Publication date: 2007-04-01

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