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Chipongo H, Rajan S, Sarkar A, Mclarty R, Sangey E. Acute necrotizing encephalopathy of childhood from Eastern Africa. Clin Case Rep 2023; 11:e7454. [PMID: 37266344 PMCID: PMC10230415 DOI: 10.1002/ccr3.7454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 05/04/2023] [Accepted: 05/18/2023] [Indexed: 06/03/2023] Open
Abstract
Key Clinical Message Acute necrotizing encephalopathy leads to devastating neurological sequelae and even death. Clinician should try not to miss this diagnosis especially in the pediatrics whenever there are neurological symptoms due to viral infection. Abstract Acute necrotizing encephalopathy (ANE) is a rare disease affecting the central nervous system. It leads to devastating neurological sequelae with a mortality rate of approximately 30%. Clinicians should have high suspicion whenever there is neurologic deficit and history of viral infections especially involving upper respiratory tract in the pediatric age group.
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Affiliation(s)
- Hilary Chipongo
- Department of Critical Care UnitShree Hindu Mandal HospitalDar es SalaamTanzania
| | - Shaffin Rajan
- Department of Critical Care UnitShree Hindu Mandal HospitalDar es SalaamTanzania
| | - Abizer Sarkar
- Department of RadiologyShree Hindu Mandal HospitalDar es SalaamTanzania
| | - Ronald Mclarty
- Department of Pediatrics and Child HealthShree Hindu Mandal HospitalDar es SalaamTanzania
| | - Esmail Sangey
- Department of Critical Care UnitShree Hindu Mandal HospitalDar es SalaamTanzania
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2
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Alshantti K, Nadarajan C, Mijol MM. A Case Report of Acute Necrotizing Encephalitis. Cureus 2022; 14:e21100. [PMID: 35165559 PMCID: PMC8829457 DOI: 10.7759/cureus.21100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/10/2022] [Indexed: 11/05/2022] Open
Abstract
Acute necrotizing encephalitis (ANEC) is a rare entity seen primarily in East Asian infants and previously healthy children. A 5-year-old boy complained of fever and seizures, which developed into status epilepticus. Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) brains showed acute necrotizing encephalitis features. Empirical treatment for meningoencephalitis with supportive therapy was administered. MRI was then repeated 25 days post-therapy, which showed the previously seen abnormal signal intensities resolution. The patient was subsequently discharged home with moderate neurological impairment. Although ANEC is a rare disease, a typical clinical scenario and MRI findings should prompt recognition of the disease, essential for treatment.
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3
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Wang ML, Liu R, Zhang LM, Zhao B, Jia R, Zhao Y, Xi YL, Ma JX, Ma H. Clinical Experience in the Diagnosis and Treatment of Adult Acute Necrotizing Encephalopathy. Neuroimmunomodulation 2022; 29:468-475. [PMID: 35760053 DOI: 10.1159/000524955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 05/06/2022] [Indexed: 12/15/2022] Open
Abstract
PURPOSE We report two cases diagnosed as acute necrotizing encephalopathy (ANE) with acute onset and various clinical manifestations. METHODS The patients' data were obtained from the medical records of the Binzhou Medical University Hospital in Binzhou, China. The clinical symptoms, laboratory examination, neuroimaging, treatment, and prognosis of the 2 patients were collected and analyzed. RESULTS We report 2 adult ANE patients with acute onset. The first symptom was fever, followed by symptoms and signs of damage to the central nervous system. The patients were infected with herpes simplex virus and influenza virus, respectively. The main manifestation on brain magnetic resonance imaging was a mixed-signal of a "three-layer structure" in the bilateral thalamus. The first patient died. Based on the experience of the diagnosis and treatment of the first patient, combined with a review of the literature, the second patient was immediately treated with glucocorticoid pulse therapy combined with gamma globulin injection. This patient's condition was controlled, and the prognosis was good. CONCLUSIONS This study describes the clinical symptoms, laboratory examination, neuroimaging evidence, and treatment experience of ANE in adults. We believe that the progress of the disease may be controlled, and the prognosis may be improved if glucocorticoid pulse therapy combined with gamma globulin injection is used as soon as possible.
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Affiliation(s)
- Mei-Ling Wang
- Department of Neurology, Binzhou Medical University Hospital, Binzhou, China,
| | - Rui Liu
- Department of Neurosurgery, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Li-Mei Zhang
- Department of Neurology, Binzhou Medical University Hospital, Binzhou, China
| | - Bin Zhao
- Department of Neurology, Binzhou Medical University Hospital, Binzhou, China
| | - Rui Jia
- Department of Neurology, Binzhou Medical University Hospital, Binzhou, China
| | - Yang Zhao
- Department of Neurology, Binzhou Medical University Hospital, Binzhou, China
| | - Ya-Lin Xi
- Department of Neurology, Binzhou Medical University Hospital, Binzhou, China
| | - Jing-Xia Ma
- Department of Neurology, Binzhou Medical University Hospital, Binzhou, China
| | - He Ma
- Department of Neurology, Binzhou Medical University Hospital, Binzhou, China
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4
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Klein DE, Libman R, Kirsch C, Arora R. Cerebral venous thrombosis: A typical presentation of COVID-19 in the young. J Stroke Cerebrovasc Dis 2020; 29:104989. [PMID: 32689590 PMCID: PMC7245247 DOI: 10.1016/j.jstrokecerebrovasdis.2020.104989] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 05/17/2020] [Accepted: 05/18/2020] [Indexed: 01/13/2023] Open
Abstract
Objective Identify clinical and radiographic features of venous infarct as a presenting feature of COVID-19 in the young. Background SARS-CoV-2 infection causes hypercoagulability and inflammation leading to venous thrombotic events (VTE). Although elderly patients with comorbidities are at higher risk, COVID-19 may also cause VTE in a broader patient population without these risks. Neurologic complications and manifestations of COVID-19, including neuropathies, seizures, strokes and encephalopathy usually occur in severe established cases of COVID-19 infection who primarily present with respiratory distress. Case description Case report of a 29-year-old woman, with no significant past medical history or comorbidities, presenting with new onset seizures. Further questioning revealed a one-week history of headaches, low-grade fever, mild cough and shortness of breath, diagnosed as COVID-19. Imaging revealed a left temporoparietal hemorrhagic venous infarction with left transverse and sigmoid sinus thrombosis treated with full dose anticoagulation and antiepileptics. Conclusion Although elderly patients with comorbidities are considered highest risk for COVID-19 neurologic complications, usually when systemic symptoms are severe, this case report emphasizes that young individuals are at risk for VTE with neurologic complications even when systemic symptoms are mild, likely induced by COVID-19 associated hypercoagulable state.
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Affiliation(s)
- David E Klein
- Department of Neurology, Zucker School of Medicine at Hofstra/Northwell Health, United States.
| | - Richard Libman
- Department of Neurology, Zucker School of Medicine at Hofstra/Northwell Health, United States.
| | - Claudia Kirsch
- Department of Radiology, Zucker School of Medicine at Hofstra/Northwell Health, United States.
| | - Rohan Arora
- Department of Neurology, Zucker School of Medicine at Hofstra/Northwell Health, United States.
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Ahmadabadi F, Ruhollahi S, Maskani R, Jafari N, Karimi Dardashti S. Three Cases of Acute Necrotizing Encephalopathy: Is It an Epidemic or Only Incidental? IRANIAN JOURNAL OF CHILD NEUROLOGY 2020; 14:87-92. [PMID: 32256627 PMCID: PMC7085126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Revised: 11/20/2018] [Accepted: 07/22/2019] [Indexed: 12/03/2022]
Abstract
Acute necrotizing encephalopathy of childhood (ANEC) is a disease, characterized by a respiratory or gastrointestinal infection, accompanied with fever, rapid alteration of consciousness, and seizures. The clinical characteristics of ANEC include acute encephalopathy following a viral infection, seizure, altered consciousness, and absence of cerebrospinal fluid (CSF) pleocytosis, with an occasional increase in the level of proteins. This disease is almost exclusively seen in previously healthy infants and children from East Asia. Serial magnetic resonance imaging (MRI) examinations have demonstrated symmetric lesions involving the thalami, brainstem, cerebellum, and white matter. ANEC has a poor prognosis with high morbidity and mortality rates. Herein, we present three cases of ANEC, who were referred to Bu-Ali Hospital of Ardabil, Iran during two weeks. Report of these three cases promoted the idea of an epidemic. The purpose of this case series was to raise the issue that ANEC may occur as an epidemic.
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Affiliation(s)
- Farzad Ahmadabadi
- Department of Pediatrics Neurology, Ardabil University of Medical Sciences (ARUMS), Ardabil, Iran
| | - Sonia Ruhollahi
- Radiologist, Ardabil University of Medical Sciences (ARUMS), Ardabil, Iran
| | - Reza Maskani
- Department of Pediatrics Neurology, Ardabil University of Medical Sciences (ARUMS), Ardabil, Iran
| | - Narjes Jafari
- Department of Pediatrics Neurology, Shahid Beheshti University of Medical Sciences (SBMU), Tehran, Iran
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Abdelrahman HS, Safwat AM, Alsagheir MM. Acute necrotizing encephalopathy in an adult as a complication of H1N1 infection. BJR Case Rep 2019; 5:20190028. [PMID: 31938561 PMCID: PMC6945259 DOI: 10.1259/bjrcr.20190028] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 06/12/2019] [Accepted: 06/20/2019] [Indexed: 01/29/2023] Open
Abstract
Acute necrotizing encephalitis is one of the recognized influenza-associated encephalopathies which has a characteristic multifocal symmetric involvement of the thalami bilaterally with only very few cases were reported in adults. We present a case of a young adult female who was presented with post-H1N1 Acute Necrotizing Encephalopathy with full neurological recovery after proper clinicoradiological diagnosis and rapid treatment with steroids and intravenous immunoglobulins.
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Affiliation(s)
- Heba S Abdelrahman
- Radiology department, Faculty of medicine, Ain Shams University, Cairo, Egypt
| | - Ahmed M Safwat
- Neurology department, Saudi German Hospital, Jeddah, Saudi Arabia
| | - Mahmoud M Alsagheir
- Anesthesia and intensive care department, Faculty of medicine, AL-Azhar University, Cairo, Egypt
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Lin YY, Lee KY, Ro LS, Lo YS, Huang CC, Chang KH. Clinical and cytokine profile of adult acute necrotizing encephalopathy. Biomed J 2019; 42:178-186. [PMID: 31466711 PMCID: PMC6717751 DOI: 10.1016/j.bj.2019.01.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 11/26/2018] [Accepted: 01/22/2019] [Indexed: 01/09/2023] Open
Abstract
Background Acute necrotizing encephalopathy (ANE), a fulminant encephalopathy, is often found in childhood. It is still uncertain whether adult patients with ANE display clinical features different from patients with typical pediatric onset. Furthermore, alterations in neuroinflammatory factors in patients with ANE have not been well-characterized. Here, we present an adult patient with ANE, and review all reported adult ANE cases in the literature. Methods Serum levels of five cytokines were checked in an adult patient with ANE and compared with gender/age-matched controls. Literature search was performed with PubMed, using the term as “acute necrotizing encephalopathy” with the filter of adult 19 + years. Results A total of 13 adult patients were reviewed. Compared with pediatric patients, adult ANE patients had similar clinical symptoms, biochemical data, and neuroimage findings, whereas adult ANE were more female-biased (female:male, 9:4) with a worse prognosis. Elevated cytokine levels in the serum and/or CSF is found in both adult-onset and pediatric-onset ANE. We found significantly elevated serum levels of IL-6 (17.17 pg/mL; healthy control: 1.43 ± 1.22 pg/mL) and VCAM-1 (3033.92 ng/mL; healthy control: 589.71 ± 133.13 ng/mL), and decreased serum TGF-β1 level (14.78 ng/mL, healthy controls: 25.81 ± 6.97 ng/mL) in our patient. Conclusions Our findings clearly delineate the clinical features and further indicate the potential change in cytokine levels in adult patients with ANE, advancing our understanding of this rare disease.
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Affiliation(s)
- Yi-Ying Lin
- Department of Neurology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Kuang-Yung Lee
- Department of Neurology, Chang Gung Memorial Hospital at Keelung, Keelung, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Long-Sun Ro
- Department of Neurology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yen-Shi Lo
- Department of Neurology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chin-Chang Huang
- Department of Neurology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Kuo-Hsuan Chang
- Department of Neurology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan.
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Odagiri A, Yamaoka A, Miyata K, Bunya N, Kasai T, Takeyama Y, Uemura S, Mikami T, Narimatsu E. Elderly-onset acute necrotizing encephalopathy mimicking severe heat stroke: a case report and review of the literature. Acute Med Surg 2019; 6:316-320. [PMID: 31304037 PMCID: PMC6603324 DOI: 10.1002/ams2.418] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2018] [Accepted: 03/16/2019] [Indexed: 11/10/2022] Open
Abstract
Background Acute necrotizing encephalopathy (ANE), known as influenza-associated encephalitis, typically affects children. Case presentation A 70-year-old woman was admitted to the hospital with altered consciousness, a high temperature, and severe hypotension. Computed tomography (CT) of the head showed no abnormalities; thus, a diagnosis of suspected severe heat stroke was made. On day 2, repeated head CT revealed bilateral symmetrical lesions to the thalamus, and a rapid influenza antigen test was positive. Based on the CT findings and the medical history of influenza, a differential diagnosis of ANE was made. Subsequently, brain edema spread across the whole brain, and the patient died on day 21. Conclusion In elderly patients, differentiating ANE from severe heat stroke in a high-temperature environment is difficult because of the similarities in clinical symptoms due to multiple organ failure.
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Affiliation(s)
- Arisa Odagiri
- Emergency and Critical Care Center Hakodate Municipal Hospital Hakodate Hokkaido Japan
| | - Ayumu Yamaoka
- Emergency and Critical Care Center Hakodate Municipal Hospital Hakodate Hokkaido Japan.,Department of Neurosurgery Sapporo Medical University Sapporo Hokkaido Japan
| | - Kei Miyata
- Department of Neurosurgery Sapporo Medical University Sapporo Hokkaido Japan.,Department of Emergency Medicine Sapporo Medical University Sapporo Hokkaido Japan
| | - Naofumi Bunya
- Department of Emergency Medicine Sapporo Medical University Sapporo Hokkaido Japan
| | - Takehiko Kasai
- Emergency and Critical Care Center Hakodate Municipal Hospital Hakodate Hokkaido Japan
| | - Yoshihiro Takeyama
- Emergency and Critical Care Center Hakodate Municipal Hospital Hakodate Hokkaido Japan
| | - Shuji Uemura
- Department of Emergency Medicine Sapporo Medical University Sapporo Hokkaido Japan
| | - Takeshi Mikami
- Department of Neurosurgery Sapporo Medical University Sapporo Hokkaido Japan
| | - Eichi Narimatsu
- Department of Emergency Medicine Sapporo Medical University Sapporo Hokkaido Japan
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Ochi N, Takahashi K, Yamane H, Takigawa N. Acute necrotizing encephalopathy in an adult with influenza A infection. Ther Clin Risk Manag 2018; 14:753-756. [PMID: 29720877 PMCID: PMC5918627 DOI: 10.2147/tcrm.s160111] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Acute necrotizing encephalopathy following influenza infection is a rapidly progressing disease with high morbidity. Although the neurological disorder is sometimes reported in children, it is very rare in adults. We herein describe an adult with acute necrotizing encephalopathy captured on a series of brain magnetic resonance images. A 55-year-old man had fever and impaired consciousness. He was diagnosed with influenza A (H1N1). Brain magnetic resonance imaging revealed symmetrical lesions in the cerebellum and basal nucleus, showing typical acute necrotizing encephalopathy. Physicians should know that influenza-associated acute necrotizing encephalopathy can occur even in middle-aged adults.
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Affiliation(s)
- Nobuaki Ochi
- Department of General Internal Medicine 4, Kawasaki Medical School, Okayama, Japan
| | - Kento Takahashi
- Clinical Education and Training Center, Kawasaki General Medical Center, Kawasaki Medical School, Okayama, Japan
| | - Hiromichi Yamane
- Department of General Internal Medicine 4, Kawasaki Medical School, Okayama, Japan
| | - Nagio Takigawa
- Department of General Internal Medicine 4, Kawasaki Medical School, Okayama, Japan
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HASSANZADEH RAD A, AMINZADEH V. Acute Necrotizing Encephalopathy of Childhood (ANEC): A Case Report. IRANIAN JOURNAL OF CHILD NEUROLOGY 2017; 11:75-77. [PMID: 28277560 PMCID: PMC5329764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Revised: 03/09/2016] [Accepted: 03/16/2016] [Indexed: 11/09/2022]
Abstract
Acute Necrotizing Encephalopathy of childhood (ANEC) is a specific type of encephalopathy. After viral infection, it can be diagnosed by bilateral symmetrical lesions predominantly observed in thalami & brainstem of infants & children. Although, it is commonly occurred in Japanese and Taiwanese population. The goal of this article is to report a rare case of ANEC in a 15 months old girl infant from Thaleghani Hospital, Ramian, Gorgan, northern Iran.
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Affiliation(s)
- Afagh HASSANZADEH RAD
- Pediatrics Growth Disorders Research Center, School of Medicine, 17th Shahrivar Hospital, Guilan University of Medical Sciences, Rasht, Iran
| | - Vahid AMINZADEH
- Pediatrics Growth Disorders Research Center, School of Medicine, 17th Shahrivar Hospital, Guilan University of Medical Sciences, Rasht, Iran
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Yoganathan S, Sudhakar SV, James EJ, Thomas MM. Acute necrotising encephalopathy in a child with H1N1 influenza infection: a clinicoradiological diagnosis and follow-up. BMJ Case Rep 2016; 2016:bcr-2015-213429. [PMID: 26759402 DOI: 10.1136/bcr-2015-213429] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Acute necrotising encephalopathy of childhood (ANEC) is a fulminant disorder with rapid progressive encephalopathy, seizures and poor outcome. It has been reported in association with various viral infections. We describe the clinicoradiological findings and short-term follow-up in a child with H1N1 influenza-associated ANEC. Laminar, target or tricolour pattern of involvement of the thalami was seen on apparent diffusion coefficient images. Our patient had significant morbidity at discharge despite early diagnosis and management with oseltamivir and immunoglobulin. Repeat imaging after 3 months had shown significant resolution of thalamic swelling, but there was persistence of cytotoxic oedema involving bilateral thalami. She was pulsed with intravenous steroids and maintained on a tapering schedule of oral steroids. This report emphasises the need for a high index of suspicion to establish early diagnosis, promotion of widespread immunisation strategies to prevent influenza outbreak, and more research to establish standard treatment protocols for this under-recognised entity.
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Affiliation(s)
- Sangeetha Yoganathan
- Department of Neurological Sciences, Christian Medical College, Vellore, Tamilnadu, India
| | - Sniya Valsa Sudhakar
- Department of Radiodiagnosis, Christian Medical College, Vellore, Tamil Nadu, India
| | - Ebor Jacob James
- Department of Pediatrics, Christian Medical College, Vellore, Tamilnadu, India
| | - Maya Mary Thomas
- Department of Neurological Sciences, Christian Medical College, Vellore, Tamilnadu, India
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Tomás J, Macário MC, Gaspar E, Santana I. Severe post-influenza (H1N1) encephalitis involving pulvinar nuclei in an adult patient. BMJ Case Rep 2015; 2015:bcr-2015-212667. [PMID: 26494725 DOI: 10.1136/bcr-2015-212667] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Neurological complications of H1N1 infections are mostly found in children, but rare cases of acute encephalopathy and post-infectious encephalitis such as acute disseminated encephalomyelitis (ADEM) have been described in adults. We report a case of an adult presenting with a progressive and severe encephalopathy that developed after H1N1 respiratory infection resolution. Cerebrospinal fluid (CSF) analysis was normal, including negative PCR for herpes simplex virus, H1N1, influenza B and JC virus, and absent oligoclonal IgG bands in CSF and serum. Initial CT scan was normal, but later MRI showed posterior multifocal leucoencephalopathy with pulvinar sign. The delayed neurological findings together with the ancillary investigation, namely the MRI pattern with both grey and white matter involvement, raised the possibility of a post-infectious process, rather than an acute encephalitis. Despite aggressive immunotherapy, the patient experienced severe neurological sequelae. Early recognition of ADEM manifestations by those dealing with H1N1 infection is important as early immunotherapy may improve the prognosis.
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Affiliation(s)
- José Tomás
- Neurology Department, Coimbra Hospital and University Centre, Coimbra, Portugal
| | - Maria Carmo Macário
- Neurology Department, Coimbra Hospital and University Centre, Coimbra, Portugal
| | - Elsa Gaspar
- Department of Internal Medicine, Coimbra Hospital and University Centre, Coimbra, Portugal
| | - Isabel Santana
- Neurology Department, Coimbra Hospital and University Centre, Coimbra, Portugal
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