title: Neurologic manifestations of E coli infection-induced hemolytic-uremic syndrome in adults.
abstract: OBJECTIVE
  To describe the neurologic and neuroradiologic complications of Shiga toxin producing Escherichia coli infection (STEC)-associated hemolytic-uremic syndrome (HUS) in adults.
  
  
  METHODS
  All 52 adult patients with STEC O104:H4 infection cared for at Hannover Medical School during the outbreak in Germany through May-July 2011 are considered in this observational study. Forty-three of the 52 patients underwent a standard neurologic diagnostic procedure including clinical examination, Mini-Mental State Examination, and Glasgow Coma Scale Score. Thirty-six patients underwent EEG, and 26 had cerebral MRI, 9 of them repeatedly. Case records of 9 patients who had not been seen by a neurologist were analyzed retrospectively.
  
  
  RESULTS
  Forty-eight of the 52 patients had HUS. All but 1 of these showed neurologic symptoms. Focal neurologic signs like double vision, difficulties in finding words, or hyperreflexia were present in 23, additional deficits in orientation, attention, memory, or constructive abilities in 9, and marked impairment of consciousness in 15. MRI showed brainstem, midbrain, thalamus, corpus callosum, and white matter lesions in half of the patients, predominantly in diffusion-weighted images. The extent of MRI lesions did not correlate with clinical symptoms. General slowing but no focal alteration was found in half of the patients examined by EEG.
  
  
  CONCLUSIONS
  Our findings suggest a toxic-metabolic pathology behind the neurologic impairment instead of multiple infarction due to microthrombosis. Future studies should aim to clarify if early antibiotic therapy or bowel cleansing might help to decrease the rate of neurologic complications in STEC-HUS.
authors.affiliation: Hannover Medical School, Hannover, Germany. weissenborn.karin@mh-hannover.de
authors.forename: Karin
authors.initials: K
authors.lastname: Weissenborn
authors.forename: Frank
authors.initials: F
authors.lastname: Donnerstag
authors.forename: Jan T
authors.initials: JT
authors.lastname: Kielstein
authors.forename: Meike
authors.initials: M
authors.lastname: Heeren
authors.forename: Hans
authors.initials: H
authors.lastname: Worthmann
authors.forename: Hartmut
authors.initials: H
authors.lastname: Hecker
authors.forename: Roland
authors.initials: R
authors.lastname: Schmitt
authors.forename: Mario
authors.initials: M
authors.lastname: Schiffer
authors.forename: Thomas
authors.initials: T
authors.lastname: Pasedag
authors.forename: Ramona
authors.initials: R
authors.lastname: Schuppner
authors.forename: Anita B
authors.initials: AB
authors.lastname: Tryc
authors.forename: Peter
authors.initials: P
authors.lastname: Raab
authors.forename: Hans
authors.initials: H
authors.lastname: Hartmann
authors.forename: Xiaoqi Q
authors.initials: XQ
authors.lastname: Ding
authors.forename: Carsten
authors.initials: C
authors.lastname: Hafer
authors.forename: Jan
authors.initials: J
authors.lastname: Menne
authors.forename: Bernhard M W
authors.initials: BM
authors.lastname: Schmidt
authors.forename: Eva
authors.initials: E
authors.lastname: Bültmann
authors.forename: Hermann
authors.initials: H
authors.lastname: Haller
authors.forename: Reinhard
authors.initials: R
authors.lastname: Dengler
authors.forename: Heinrich
authors.initials: H
authors.lastname: Lanfermann
authors.forename: Anja M
authors.initials: AM
authors.lastname: Giesemann
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001921:Brain / Q000382:microbiology / Q000473:pathology; D004569:Electroencephalography; D004927:Escherichia coli Infections / Q000150:complications*; D005260:Female; D006463:Hemolytic-Uremic Syndrome / Q000150:complications / Q000209:etiology / Q000382:microbiology; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008609:Mental Status Schedule; D008875:Middle Aged; D009422:Nervous System Diseases / Q000175:diagnosis / Q000209:etiology*; D019370:Observation; D011446:Prospective Studies; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D055815:Young Adult