Central nervous system involvement in adults with epidemic hemolytic uremic syndrome

Hemolytic uremic syndrome is a multisystem disorder that is caused by infection with Shiga-toxin-producing Escherichia coli. HUS affects mainly children and is rare among adults. This retrospective case series analyzes clinical signs and MR imaging findings of 11 adult patients with HUS associated nervous system involvement during the epidemic EHEC outbreak in northern Europe with its epicenter in Hamburg in May 2011. The most prevalent imaging finding was symmetric pointy vasogenic edema of the brain stem in the acute and subacute phases of the disease (n = 5). One patient exhibited additional symmetric mesiotemporal signal changes mimicking limbic encephalitis. Two patients developed subcortical patchy lesions, and 4 subjects did not present with any signal changes. Remarkably, territorial ischemia, signs of hemorrhage, or blood-brain barrier disruption have not been detected. While brain stem lesions were transient and normalized with clinical recovery, supratentorial lesions did not resolve completely at 2-month follow-up examination.

Transcranial grey-scale sonography of subdural haematoma in adults

AIM

Transcranial high-resolution grey-scale sonography reliably allows diagnosis and monitoring of subdural haematoma (SDH) and extra-cerebral intracranial fluid collections in infants but has not been evaluated thoroughly in adults up to now. Because of rapid development of ultrasound systems, the depiction of intracerebral haemorrhage (ICH) has now become feasible. The presented study evaluated the sonographic appearance of SDH in adults.

METHOD

We performed transcranial grey-scale sonography (TGS) in 25 consecutive patients with SDH confirmed by cranial computed tomography (CCT) or MRI. According to paediatric TGS, the dural border of the arachnoid was depicted as a highly echogenic membrane, and the distance between the skull and the echogenic membrane was measured. SDH was measured by CCT/MRI and by TGS in corresponding axial planes. The rate of identification of SDH in TGS was evaluated, and the extent of SDH as assessed by CCT/MRI and TGS was compared.

RESULTS

TGS reliably detected SDH in 22 of the 25 patients with confirmed SDH (88 %). In the remaining 3 patients, the temporal bone window was insufficient for TGS investigation. Extent of SDH measured by CCT and TGS correlated linearly (r= 0.849).

CONCLUSION

TGS allows imaging of SDH in patients with CCT/MRI confirmed SDH, and the extent of SDH correlates significantly between TGS and CCT/MRI. Therefore, TGS may be a possible alternative to serial CCT imaging in monitoring SDH, since in contrast to CCT, TGS is a non-invasive bedside method. So far, TGS is not suitable for the diagnosis of SDH.