Recovery of thalamic microstructural damage after Shiga toxin 2-associated hemolytic-uremic syndrome

J Neurol Sci. 2015 Sep 15;356(1-2):175-83. doi: 10.1016/j.jns.2015.06.045. Epub 2015 Jun 23.


Introduction: The underlying pathophysiology of neurological complications in patients with hemolytic-uremic syndrome (HUS) remains unclear. It was recently attributed to a direct cytotoxic effect of Shiga toxin 2 (Stx2) in the thalamus. Conventional MRI of patients with Stx2-caused HUS revealed - despite severe neurological symptoms - only mild alterations if any, mostly in the thalamus. Against this background, we questioned: Does diffusion tensor imaging (DTI) capture the thalamic damage better than conventional MRI? Are neurological symptoms and disease course better reflected by thalamic alterations as detected by DTI? Are other brain regions also affected?

Methods: Three women with serious neurological deficits due to Stx2-associated HUS were admitted to MRI/DTI at disease onset. Two of them were longitudinally examined. Fractional anisotropy (FA) and mean diffusivity were computed to assess Stx2-caused microstructural damage.

Results: Compared to 90 healthy women, all three patients had significantly reduced thalamic FA. Thalamic mean diffusivity was only reduced in two patients. DTI of the longitudinally examined women demonstrated slow normalization of thalamic FA, which was paralleled by clinical improvement.

Conclusion: Whereas conventional MRI only shows slight alterations based on subjective evaluation, DTI permits quantitative, objective, and longitudinal assessment of cytotoxic cerebral damage in individual patients.

Keywords: Cytotoxic microstructural thalamic damage; DTI; Hemolytic–uremic syndrome; MRI; Shiga toxin 2; Thalamic recovery.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Anisotropy
  • Diffusion Tensor Imaging
  • Female
  • Hemolytic-Uremic Syndrome / chemically induced*
  • Hemolytic-Uremic Syndrome / diagnosis*
  • Hemolytic-Uremic Syndrome / physiopathology
  • Hemolytic-Uremic Syndrome / therapy
  • Humans
  • Image Processing, Computer-Assisted
  • Male
  • Middle Aged
  • Plasmapheresis / methods
  • Recovery of Function*
  • Shiga Toxin 2 / toxicity*
  • Thalamus / pathology*


  • Shiga Toxin 2