Acute encephalopathy with fatty infiltration of the viscera

Reye syndrome

Reye syndrome has emerged as the quintessential example of an acute metabolic encephalopathy with an annual incidence ranging from 0.3 to 6.0 cases per 100,000 children. The general management has become standardized, and the mortality has declined to approximately 10 per cent. The role of aspirin in the etiopathogenesis remains controversial.

Reye's syndrome; diagnosis by muscle biopsy?

Three children with Reye's syndrome are described. One child died, the second had mild and transient illness, and the third had recurrent episodes. In all 3 children a muscle biopsy showed pronounced infiltration of the myofibres with fat microdroplets as shown by the oil red O stain and by electron microscopical examination. We suggest that needle biopsy of muscle may be a quick and safe aid to the diagnosis of Reye's syndrome, and may be preferable to liver biopsy in view of the pronounced tendency to bleed in Reye's syndrome.

Reye syndrome associated with Hemophilus influenzae infection

A case of Reye syndrome in an infant associated with culture-proven Hemophilus influenzae type d infection and probable meningitis is presented. This represents the second such reported case and the first to be described in detail. The criteria for the clinical and chemical diagnosis of Reye syndrome are reviewed. Pertinent and abnormal features of this patient's presentation are discussed. The finding of a non-visualizing liver on technetium-99m sulfur colloid isotope scan and possible mechanisms are discussed.

Heatstroke in well-wrapped infants

In a 3-year period in Newcastle upon Tyne a sudden illness, of which the main features were fever, shock, convulsions, hepatic disturbance, and a bleeding tendency, affected 5 infants, 4 of whom died. No aetiological agent could be demonstrated, and in the absence of a satisfactory alternative diagnosis it is suggested that a principal component of the illness was heatstroke, brought about by excessive wrapping or warming during a mild infection.