Acute Necrotizing Encephalopathy of Childhood: A Single-Center Experience

Turk J Med Sci. 2021 Mar 23. doi: 10.3906/sag-2102-47. Online ahead of print.

Abstract

Background/aim: Acute necrotizing encephalopathy is a rare type of acute encephalopathy characterized by multi-focal brain lesions and associated severe neurological findings and various organ dysfunctions may accompany it.

Material and methods: Patients with acute necrotizing encephalopathy of childhood diagnosed by pediatric neurology and pediatric intensive care at Sami Ulus Maternity, Child Health and Diseases Training and Research Hospital between 2007 and 2020 were included in this study.

Results: Nine patients (six females, three males) with a mean age of 4.05±1.94 years (age range 1-6.5) were included in this study. The interval range between fever and encephalopathy in patients was 1-4 days. Influenza A (3H1N1, one untyped) was detected in four patients, influenza B in three patients, and no cause was found in two patients. Major clinical findings other than febrile encephalopathy in all patients were a hemodynamic shock in seven patients, seizures in six patients, vomiting in five patients, dystonia in three patients, and flaccid paralysis in the upper extremity in one patient. Despite all our treatment approaches, including plasmapheresis, moderate to severe neurological sequelae was observed in all of our patients, who survived even with significant radiological improvement. Three patients for whom we could not perform plasmapheresis died.

Conclusion: Our study revealed that thalamic involvement increased as the interval shortened, and brainstem involvement increased in patients over four years of age. The presence of persistent vomiting accompanying encephalopathy during the parainfectious period and plasmapheresis treatment being a treatment option that could prevent mortality were cautionary for our study.

Keywords: Febrile illness; childhood; encephalopathy; multi-focal brain lesions; seizure(s).