Single-Photon Emission Computed Tomography Is an Ambiguous Imaging Method on Initial Diagnosis for Acute Encephalopathy

Gaku Yamanaka; Nastumi Morishita; Shingo Oana; Mika Takeshita; Shinichiro Morichi; Yu Ishida; Yasuyo Kashiwagi; Hisashi Kawashima

doi:10.1055/s-0035-1570321

Neuropediatrics, Table of Contents

Neuropediatrics 2016; 47(01): 039-045
DOI: 10.1055/s-0035-1570321

Original Article

Georg Thieme Verlag KG Stuttgart · New York

Single-Photon Emission Computed Tomography Is an Ambiguous Imaging Method on Initial Diagnosis for Acute Encephalopathy

Authors

Gaku Yamanaka

¹Department of Pediatrics, Tokyo Medical University, Shinjuku, Tokyo, Japan
Nastumi Morishita

¹Department of Pediatrics, Tokyo Medical University, Shinjuku, Tokyo, Japan
Shingo Oana

¹Department of Pediatrics, Tokyo Medical University, Shinjuku, Tokyo, Japan
Mika Takeshita

¹Department of Pediatrics, Tokyo Medical University, Shinjuku, Tokyo, Japan
Shinichiro Morichi

¹Department of Pediatrics, Tokyo Medical University, Shinjuku, Tokyo, Japan
Yu Ishida

¹Department of Pediatrics, Tokyo Medical University, Shinjuku, Tokyo, Japan
Yasuyo Kashiwagi

¹Department of Pediatrics, Tokyo Medical University, Shinjuku, Tokyo, Japan
Hisashi Kawashima

¹Department of Pediatrics, Tokyo Medical University, Shinjuku, Tokyo, Japan

Abstract

The distinction between acute encephalopathy (AE) and convulsive disorders with pyrexia may be problematic. We analyzed the clinical and laboratory features in 127 children who were admitted for suspected AE. They were categorized into (1) definite acute encephalopathy group (DAEG; n = 17, abnormal findings on electroencephalography [EEG], magnetic resonance imaging, or single-photon emission computed tomography [SPECT] with prolonged impaired consciousness), (2) probable acute encephalopathy group (PAEG; n = 21, abnormal findings without prolonged impaired consciousness), and (3) nonacute encephalopathy group (NAEG; n = 89). Cerebrospinal fluid interleukin-6 (CSF IL-6), and serum aspartate aminotransferase (AST), alanine aminotransferase (ALT), and creatine phosphokinase levels were significantly higher in DAEG compared with NAEG but not PAEG. No significant differences were observed between DAEG and PAEG except for serum creatinine levels. In PAEG, an area of hypoperfusion was observed on SPECT images of nine patients with normal CSF IL-6 levels. AE was suspected in two PAEG patients who exhibited high CSF IL-6 levels and abnormal EEG findings without abnormal SPECT findings. All seven patients with severe neurological sequelae were categorized to DAEG. CSF IL-6 and serum AST, ALT, and creatine kinase levels may be valid predictors of typical AE; prolonged impaired consciousness is an important sign of AE. However, SPECT may not be suitable for initial diagnosis of AE.

Keywords

acute encephalopathy - cytokine - single-photon emission computed tomography - febrile seizures - interleukin-6

Full Text

References

References
1 Morishima T, Togashi T, Yokota S , et al; Collaborative Study Group on Influenza-Associated Encephalopathy in Japan. Encephalitis and encephalopathy associated with an influenza epidemic in Japan. Clin Infect Dis 2002; 35 (5) 512-517
2 Kawashima H, Kashiwagi Y, Ioi H , et al. Production of chemokines in respiratory syncytial virus infection with central nervous system manifestations. J Infect Chemother 2012; 18 (6) 827-831
3 Denier C, Balu L, Husson B , et al. Familial acute necrotizing encephalopathy due to mutation in the RANBP2 gene. J Neurol Sci 2014; 345 (1–2) 236-238
4 Shinohara M, Saitoh M, Takanashi J , et al. Carnitine palmitoyl transferase II polymorphism is associated with multiple syndromes of acute encephalopathy with various infectious diseases. Brain Dev 2011; 33 (6) 512-517
5 Shinohara M, Saitoh M, Nishizawa D , et al. ADORA2A polymorphism predisposes children to encephalopathy with febrile status epilepticus. Neurology 2013; 80 (17) 1571-1576
6 Hosoya M, Nunoi H, Aoyama M, Kawasaki Y, Suzuki H. Cytochrome c and tumor necrosis factor-alpha values in serum and cerebrospinal fluid of patients with influenza-associated encephalopathy. Pediatr Infect Dis J 2005; 24 (5) 467-470
7 Yamanaka G, Kawashima H, Suganami Y , et al. Diagnostic and predictive value of CSF d-ROM level in influenza virus-associated encephalopathy. J Neurol Sci 2006; 243 (1–2) 71-75
8 Kawashima H, Watanabe Y, Morishima T , et al. NOx (nitrite/nitrate) in cerebral spinal fluids obtained from patients with influenza-associated encephalopathy. Neuropediatrics 2003; 34 (3) 137-140
9 Morichi S, Kawashima H, Ioi H , et al. Classification of acute encephalopathy in respiratory syncytial virus infection. J Infect Chemother 2011; 17 (6) 776-781
10 Mizuguchi M, Yamanouchi H, Ichiyama T, Shiomi M. Acute encephalopathy associated with influenza and other viral infections. Acta Neurol Scand 2007; 115 (4, Suppl): 45-56
11 Yamanouchi H, Kawaguchi N, Mori M , et al. Acute infantile encephalopathy predominantly affecting the frontal lobes. Pediatr Neurol 2006; 34 (2) 93-100
12 Takanashi J, Oba H, Barkovich AJ , et al. Diffusion MRI abnormalities after prolonged febrile seizures with encephalopathy. Neurology 2006; 66 (9) 1304-1309 , discussion 1291
13 Hoshino A, Saitoh M, Oka A , et al. Epidemiology of acute encephalopathy in Japan, with emphasis on the association of viruses and syndromes. Brain Dev 2012; 34 (5) 337-343
14 Shiihara T, Miyake T, Izumi S , et al. Serum and cerebrospinal fluid S100B, neuron-specific enolase, and total tau protein in acute encephalopathy with biphasic seizures and late reduced diffusion: a diagnostic validity. Pediatr Int 2012; 54 (1) 52-55
15 Tsukahara H, Fujii Y, Matsubara K , et al. Prognostic value of brain injury biomarkers in acute encephalitis/encephalopathy. Pediatr Int 2013; 55 (4) 461-464
16 Nakamura M, Yamanaka G, Kawashima H , et al. Clinical application of rapid assay of interleukin-6 in influenza-associated encephalopathy. Dis Markers 2005; 21 (4) 199-202
17 Nagao T, Morishima T, Kimura H , et al. Prognostic factors in influenza-associated encephalopathy. Pediatr Infect Dis J 2008; 27 (5) 384-389
18 Ichiyama T, Ito Y, Kubota M, Yamazaki T, Nakamura K, Furukawa S. Serum and cerebrospinal fluid levels of cytokines in acute encephalopathy associated with human herpesvirus-6 infection. Brain Dev 2009; 31 (10) 731-738
19 Nagase H, Nakagawa T, Aoki K , et al. Therapeutic indicators of acute encephalopathy in patients with complex febrile seizures. Pediatr Int 2013; 55 (3) 310-314
20 Morita H, Hosoya M, Kato A, Kawasaki Y, Suzuki H. Laboratory characteristics of acute encephalopathy with multiple organ dysfunctions. Brain Dev 2005; 27 (7) 477-482
21 Yoshinari S, Hamano S, Minamitani M, Tanaka M, Eto Y. Human herpesvirus 6 encephalopathy predominantly affecting the frontal lobes. Pediatr Neurol 2007; 36 (1) 13-16
22 Dierckx RA, Melis K, Dom L , et al. Technetium-99m hexamethylpropylene amine oxime single photon emission tomography in febrile convulsions. Eur J Nucl Med 1992; 19 (4) 278-282
23 Hirayama K, Sakazaki H, Murakami S , et al. Sequential MRI, SPECT and PET in respiratory syncytial virus encephalitis. Pediatr Radiol 1999; 29 (4) 282-286
24 Kurihara M, Nakae Y, Kohagizawa T, Eto Y. Brain perfusion single photon emission computed tomography in children after acute encephalopathy [in Japanese]. No To Hattatsu 2005; 37 (4) 289-292