title: Characteristic neuroradiologic features in hemorrhagic shock and encephalopathy syndrome.
abstract: Hemorrhagic shock and encephalopathy syndrome is a devastating disease, but the pathogenesis remains unclear. The aim of this study was to examine the usefulness of neuroimaging in establishing a diagnosis and elucidating the pathogenesis. We analyzed the neuroradiologic features of 22 patients who fulfilled the Levin criteria. All patients underwent brain computed tomography (CT), and 14 patients underwent brain magnetic resonance imaging (MRI) including diffusion-weighted imaging in 10 patients. Initial CT showed normal findings in 14 of 18 (78%) patients, but subsequently hypodensities appeared in bilateral watershed zones and progressed to whole brain edema. MRI revealed cytotoxic edema, showing hyperintensities in bilateral watershed zones on diffusion-weighted imaging with a low apparent diffusion coefficient. Serial neuroimaging showed characteristic features of a widespread brain ischemic event mainly in watershed zones in hemorrhagic shock and encephalopathy syndrome.
authors.affiliation: Department of Pediatric Neurology, Osaka City General Hospital, Osaka, Japan gpkichiro0926@yahoo.co.jp.
authors.forename: Ichiro
authors.initials: I
authors.lastname: Kuki
authors.affiliation: Department of Pediatric Emergency Medicine, Osaka City General Hospital, Osaka, Japan.
authors.forename: Masashi
authors.initials: M
authors.lastname: Shiomi
authors.affiliation: Department of Pediatric Neurology, Osaka City General Hospital, Osaka, Japan.
authors.forename: Shin
authors.initials: S
authors.lastname: Okazaki
authors.affiliation: Department of Pediatric Neurology, Osaka City General Hospital, Osaka, Japan.
authors.forename: Hisashi
authors.initials: H
authors.lastname: Kawawaki
authors.affiliation: Department of Pediatric Neurology, Osaka City General Hospital, Osaka, Japan.
authors.forename: Kiyotaka
authors.initials: K
authors.lastname: Tomiwa
authors.affiliation: Department of Pediatric Emergency Medicine, Osaka City General Hospital, Osaka, Japan.
authors.forename: Kiyoko
authors.initials: K
authors.lastname: Amo
authors.affiliation: Department of Pediatric Emergency Medicine, Osaka City General Hospital, Osaka, Japan.
authors.forename: Masao
authors.initials: M
authors.lastname: Togawa
authors.affiliation: Emergency and Critical Care Medical Center, Osaka City General Hospital, Osaka, Japan.
authors.forename: Junichi
authors.initials: J
authors.lastname: Ishikawa
authors.affiliation: Emergency and Critical Care Medical Center, Osaka City General Hospital, Osaka, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Rinka
mesh_terms: D001778:Blood Coagulation Disorders; D001921:Brain / Q000473:pathology*; D001927:Brain Diseases; D002648:Child; D002675:Child, Preschool; D009358:Congenital, Hereditary, and Neonatal Diseases and Abnormalities / Q000097:blood / Q000473:pathology* / Q000652:urine; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008279:Magnetic Resonance Imaging; D008297:Male; D012771:Shock, Hemorrhagic; D014057:Tomography, X-Ray Computed
keywords: acute encephalopathy; diffusion-weighted image; viral infection