title: Subacute encephalopathy: clinical features, laboratory data, neuroimaging, and outcomes.
abstract: We sought to clarify the clinical, laboratory, neuroradiologic, and neurophysiologic features of the "subacute" subtype of encephalopathy. We retrospectively identified nine patients with subacute encephalopathy out of 97 patients diagnosed as manifesting acute encephalopathy. Neurologic symptoms, clinical course, laboratory data, neuroradiologic and electroencephalographic findings, and outcomes were reviewed through medical records. The median age of patients was 44 months (range, 28-156 months). The initial neurologic sign was a brief seizure in 4, a prolonged seizure in 3, delirious behavior in 1, and a loss of consciousness in 1. Loss of consciousness the next day was subtle in 4, and mild in 5. However, a worsening of consciousness was observed 3-7 days after onset. Laboratory data were unremarkable, and electroencephalography during the early phase found abnormalities in 4 of 7 patients. Magnetic resonance imaging revealed no abnormalities during the early phase, and mild cortical atrophy during the late phase. All but one patient had various degrees of neurologic sequelae. Subacute encephalopathy was characterized by a delayed worsening of neurologic symptoms, mild cortical atrophy on late magnetic resonance imaging, and poor neurologic outcomes. Recognition of this type of acute encephalopathy is important, and a method to promote early diagnosis is desirable.
authors.affiliation: Department of Pediatrics, Juntendo University School of Medicine, Tokyo, Japan. okumura@med.juntendo.ac.jp
authors.forename: Akihisa
authors.initials: A
authors.lastname: Okumura
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Kidokoro
authors.forename: Kazuya
authors.initials: K
authors.lastname: Itomi
authors.forename: Koichi
authors.initials: K
authors.lastname: Maruyama
authors.forename: Tetsuo
authors.initials: T
authors.lastname: Kubota
authors.forename: Yoko
authors.initials: Y
authors.lastname: Kondo
authors.forename: Seiko
authors.initials: S
authors.lastname: Itomi
authors.forename: Naoko
authors.initials: N
authors.lastname: Uemura
authors.forename: Jun
authors.initials: J
authors.lastname: Natsume
authors.forename: Kazuyoshi
authors.initials: K
authors.lastname: Watanabe
authors.forename: Tsuneo
authors.initials: T
authors.lastname: Morishima
mesh_terms: D000293:Adolescent; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D000927:Anticonvulsants / Q000627:therapeutic use; D001921:Brain / Q000473:pathology; D002648:Child; D002652:Child Behavior; D002675:Child, Preschool; D003072:Cognition Disorders / Q000209:etiology / Q000523:psychology; D003907:Dexamethasone / Q000627:therapeutic use; D018450:Disease Progression; D004569:Electroencephalography; D005260:Female; D006801:Humans; D007888:Leigh Disease / Q000473:pathology / Q000523:psychology / Q000628:therapy*; D008279:Magnetic Resonance Imaging; D008297:Male; D008775:Methylprednisolone / Q000627:therapeutic use; D012640:Seizures / Q000209:etiology / Q000503:physiopathology; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014474:Unconsciousness / Q000209:etiology
chemical_list: D000893:Anti-Inflammatory Agents; D000927:Anticonvulsants; D003907:Dexamethasone; D008775:Methylprednisolone