Prognostic factors for acute encephalopathy with bright tree appearance.
OBJECTIVE
To determine the prognostic factors for encephalopathy with bright tree appearance (BTA) in the acute phase through retrospective case evaluation.


METHODS
We recruited 10 children with encephalopathy who presented with BTA and classified them into 2 groups. Six patients with evident regression and severe psychomotor developmental delay after encephalopathy were included in the severe group, while the remaining 4 patients with mild mental retardation were included in the mild group. We retrospectively analyzed their clinical symptoms, laboratory data, and magnetic resonance imaging (MRI) and magnetic resonance spectroscopy (MRS) findings.


RESULTS
Patients in the severe group developed subsequent complications such as epilepsy and severe motor impairment. Univariate analysis revealed that higher maximum lactate dehydrogenase (LDH) levels (p=0.055) were a weak predictor of poor outcome. Maximum creatinine levels were significantly higher (p<0.05) and minimal platelet counts were significantly lower (p<0.05) in the severe group than in the mild group. Acute renal failure was not observed in any patient throughout the study. MRS of the BTA lesion during the BTA period showed elevated lactate levels in 5 children in the severe group and 1 child in the mild group. MRI performed during the chronic phase revealed severe brain atrophy in all patients in the severe group.


CONCLUSIONS
Higher creatinine and LDH levels and lower platelet counts in the acute phase correlated with poor prognosis. Increased lactate levels in the BTA lesion during the BTA period on MRS may predict severe physical and mental disability.
Department of Pediatrics, Osaka University Graduate School of Medicine, Japan; Epilepsy Center, Osaka University Hospital, Japan. Electronic address: jazuma@ped.med.osaka-u.ac.jp.
Junji
J
Azuma
Department of Pediatrics, Osaka University Graduate School of Medicine, Japan; Epilepsy Center, Osaka University Hospital, Japan.
Shin
S
Nabatame
Department of Pediatrics, Osaka University Graduate School of Medicine, Japan; Epilepsy Center, Osaka University Hospital, Japan.
Sayaka
S
Nakano
Department of Pediatrics, Osaka University Graduate School of Medicine, Japan; Epilepsy Center, Osaka University Hospital, Japan.
Yoshiko
Y
Iwatani
Department of Pediatrics, Morinomiya Hospital, Japan.
Yukihiro
Y
Kitai
Department of Pediatrics, Osaka University Graduate School of Medicine, Japan; Epilepsy Center, Osaka University Hospital, Japan; United Graduate School of Child Development, Osaka University Graduate School of Medicine, Japan.
Koji
K
Tominaga
Department of Pediatrics, Osaka University Graduate School of Medicine, Japan; Epilepsy Center, Osaka University Hospital, Japan; United Graduate School of Child Development, Osaka University Graduate School of Medicine, Japan.
Kuriko
K
Kagitani-Shimono
Department of Pediatrics, Osaka University Graduate School of Medicine, Japan; Epilepsy Center, Osaka University Hospital, Japan.
Takeshi
T
Okinaga
Department of Pediatrics, Minoh City Hospital, Japan.
Takehisa
T
Yamamoto
Division of Health Science, Osaka University Graduate School of Medicine, Japan.
Toshisaburo
T
Nagai
Department of Pediatrics, Osaka University Graduate School of Medicine, Japan; Epilepsy Center, Osaka University Hospital, Japan.
Keiichi
K
Ozono
D000208:Acute Disease; D014151:Anti-Anxiety Agents / Q000627:therapeutic use; D001921:Brain / Q000378:metabolism* / Q000473:pathology*; D001927:Brain Diseases / Q000097:blood* / Q000150:complications / Q000175:diagnosis*; D002648:Child; D002675:Child, Preschool; D003404:Creatinine / Q000097:blood; D003975:Diazepam / Q000627:therapeutic use; D004827:Epilepsy / Q000150:complications; D006801:Humans; D007223:Infant; D007770:L-Lactate Dehydrogenase / Q000097:blood; D008279:Magnetic Resonance Imaging; D009682:Magnetic Resonance Spectroscopy; D008874:Midazolam / Q000627:therapeutic use; D012189:Retrospective Studies
D014151:Anti-Anxiety Agents; D003404:Creatinine; D007770:L-Lactate Dehydrogenase; D003975:Diazepam; D008874:Midazolam
Acute encephalopathy; Acute encephalopathy with biphasic seizures and late reduced diffusion; Bright tree appearance; Creatinine; Lactate peak; Magnetic resonance spectroscopy; Prognostic factors