title: Differences of clinical manifestations according to the patterns of brain lesions in acute encephalopathy with reduced diffusion in the bilateral hemispheres.
abstract: OBJECTIVE
  The precise clinical characteristics of acute encephalopathy with bilateral reduced diffusion are not fully understood. We compared clinical, laboratory, and neuroimaging findings according to the patterns of brain lesions among children with reduced diffusion in the bilateral hemispheres.
  
  
  METHODS
  Nine patients were analyzed. The patterns of brain lesions were divided into diffuse lesions and central-sparing lesions. Diffuse lesions were defined as reduced diffusion in the whole cortex and/or subcortical white matter. Central-sparing lesions were defined as the lack of reduced diffusion in the areas around the bilateral Sylvian fissures. Clinical, laboratory, and neuroimaging findings were compared between groups.
  
  
  RESULTS
  Five patients showed diffuse lesions and 4 showed central-sparing lesions. Coma was significantly more common in patients with diffuse lesions, whereas a biphasic clinical course was more common in those with central-sparing lesions. Outcome was worse in patients with diffuse lesions. Maximal aspartate aminotransferase, alanine aminotransferase, and kinase levels were also significantly higher in patients with diffuse lesions. In 2 patients with diffuse lesions, diffusion-weighted images during the acute phase revealed reduced diffusion in the bilateral frontal and occipital areas, followed by diffuse lesions. No patient with central-sparing lesions showed MR imaging abnormalities during the acute phase.
  
  
  CONCLUSIONS
  Clinical manifestations in patients with diffuse lesions were severe, whereas those in patients with central-sparing lesions were relatively mild.
authors.affiliation: Department of Pediatrics, Juntendo University School of Medicine, Tokyo, Japan. okumura@juntendo.ac.jp
authors.forename: A
authors.initials: A
authors.lastname: Okumura
authors.forename: H
authors.initials: H
authors.lastname: Kidokoro
authors.forename: T
authors.initials: T
authors.lastname: Tsuji
authors.forename: M
authors.initials: M
authors.lastname: Suzuki
authors.forename: T
authors.initials: T
authors.lastname: Kubota
authors.forename: T
authors.initials: T
authors.lastname: Kato
authors.forename: M
authors.initials: M
authors.lastname: Komatsu
authors.forename: T
authors.initials: T
authors.lastname: Shono
authors.forename: F
authors.initials: F
authors.lastname: Hayakawa
authors.forename: T
authors.initials: T
authors.lastname: Shimizu
authors.forename: T
authors.initials: T
authors.lastname: Morishima
mesh_terms: D000208:Acute Disease; D002540:Cerebral Cortex / Q000473:pathology*; D002675:Child, Preschool; D003128:Coma / Q000473:pathology*; D038524:Diffusion Magnetic Resonance Imaging; D004660:Encephalitis / Q000473:pathology*; D005260:Female; D007839:Functional Laterality; D006801:Humans; D007223:Infant; D008297:Male; D009413:Nerve Fibers, Myelinated / Q000473:pathology; D012720:Severity of Illness Index