title: Prognostic factors in acute encephalopathy with reduced subcortical diffusion.
abstract: OBJECTIVE
  Acute encephalopathy with reduced subcortical diffusion (AED) covers a spectrum including not only typical acute encephalopathy with biphasic seizures and late reduced diffusion (AESD) but also atypical AESD with monophasic clinical course, or more severe subtypes. Aim of this study is to analyze prognostic factors of AED.
  
  
  METHODS
  We recruited 33 children with AED, that is, widespread diffusion restriction in cortical and subcortical structures. Their clinical courses, laboratory data, MRI, and the efficacy of treatment were analyzed retrospectively.
  
  
  RESULTS
  Of the 33 children, 20 were males and the mean age at diagnosis was 22 months. Eighteen children had good outcome and 15 had poor outcome. Univariate analysis showed loss of consciousness 24 h after the onset, prolonged seizure at the onset, and mechanical ventilation to be weak predictors of poor outcome. Maximal aspartate aminotransferase, alanine aminotransferase, and creatinine kinase levels were significantly higher in the poor outcome group. Multivariate analysis showed loss of consciousness 24 h after the onset and prolonged seizure at the onset to be poor predictors of AED. Treatment with steroids and/or immunoglobulins did not result in better outcome.
  
  
  CONCLUSIONS
  Prolonged seizure at the onset and loss of consciousness 24 h after the onset were seen at early stages of severe AED. Using these features, a prospective study of early intervention in AED should be conducted to further analyze the efficacy of its treatment.
authors.affiliation: Department of Pediatrics, Hekinan Municipal Hospital, Aichi, Japan. naokohayashi11@hotmail.com
authors.forename: Naoko
authors.initials: N
authors.lastname: Hayashi
authors.forename: Akihisa
authors.initials: A
authors.lastname: Okumura
authors.forename: Tetsuo
authors.initials: T
authors.lastname: Kubota
authors.forename: Takeshi
authors.initials: T
authors.lastname: Tsuji
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Kidokoro
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Fukasawa
authors.forename: Fumio
authors.initials: F
authors.lastname: Hayakawa
authors.forename: Naoki
authors.initials: N
authors.lastname: Ando
authors.forename: Jun
authors.initials: J
authors.lastname: Natsume
mesh_terms: D001927:Brain Diseases / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D011379:Prognosis; D012640:Seizures / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology