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Yasukohchi M, Omata T, Ochiai K, Sano K, Murofushi Y, Kimura S, Takase N, Honda T, Yasukawa K, Takanashi JI. Pathomechanism of infantile traumatic brain injury with a biphasic clinical course and late reduced diffusion evaluated by MR spectroscopy. J Neurol Sci 2024; 466:123228. [PMID: 39278172 DOI: 10.1016/j.jns.2024.123228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2024] [Revised: 08/26/2024] [Accepted: 09/08/2024] [Indexed: 09/17/2024]
Abstract
BACKGROUND Infantile traumatic brain injury (TBI) with a biphasic clinical course and late reduced diffusion (TBIRD) has recently been reported as a distinct type of TBI in infancy. However, the pathological and prognostic factors of TBIRD remain unknown. We aimed to compare patients with and without TBIRD and evaluate the pathomechanism of TBIRD using magnetic resonance spectroscopy (MRS). METHODS Ten Japanese patients with TBI were admitted to our hospital and underwent MRS between September 2015 and September 2022 (age range, 3-15 months; median age, 8.5 months). TBIRD was diagnosed in six patients. MRS data were compared among patients with TBIRD, patients without TBIRD, and controls. Neurological prognosis was classified into grades 1 (normal) to 3 (severe). RESULTS In patients with TBIRD, MRS revealed an increase in the glutamine (Gln) level on days 3-29, which subsequently became close to normal. The degree of Gln elevation in the non-TBIRD group was smaller (117-158 % of controls) than that in the TBIRD group (210-337 %) within 14 days. MRS in the TBIRD group showed decreased N-acetyl aspartate (NAA) concentrations. The degree of NAA decrease was more prominent in grade 3 than in grades 1 and 2. NAA levels in the non-TBIRD group were almost normal. CONCLUSIONS Patients with TBI and markedly elevated Gln levels on MRS may develop TBIRD. Neuro-excitotoxicity is a possible pathological mechanism of TBIRD. Decreased NAA levels may be useful for predicting the prognosis of patients with TBIRD.
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Affiliation(s)
- Madoka Yasukohchi
- Department of Pediatrics, Tokyo Women's Medical University Yachiyo Medical Center, 477-96 Owadashinden, Yachiyo-shi, Chiba 276-8524, Japan.
| | - Taku Omata
- Department of Pediatrics, Tokyo Women's Medical University Yachiyo Medical Center, 477-96 Owadashinden, Yachiyo-shi, Chiba 276-8524, Japan.
| | - Kenta Ochiai
- Department of Pediatrics, Tokyo Women's Medical University Yachiyo Medical Center, 477-96 Owadashinden, Yachiyo-shi, Chiba 276-8524, Japan
| | - Kentaro Sano
- Department of Pediatrics, Tokyo Women's Medical University Yachiyo Medical Center, 477-96 Owadashinden, Yachiyo-shi, Chiba 276-8524, Japan
| | - Yuka Murofushi
- Department of Pediatrics, Tokyo Women's Medical University Yachiyo Medical Center, 477-96 Owadashinden, Yachiyo-shi, Chiba 276-8524, Japan
| | - Sho Kimura
- Department of Pediatric Critical Care Medicine, Tokyo Women's Medical University Yachiyo Medical Center, 477-96 Owadashinden, Yachiyo-shi, Chiba 276-8524, Japan
| | - Nanako Takase
- Department of Pediatrics, Tokyo Women's Medical University Yachiyo Medical Center, 477-96 Owadashinden, Yachiyo-shi, Chiba 276-8524, Japan
| | - Takafumi Honda
- Department of Pediatric Critical Care Medicine, Tokyo Women's Medical University Yachiyo Medical Center, 477-96 Owadashinden, Yachiyo-shi, Chiba 276-8524, Japan.
| | - Kumi Yasukawa
- Department of Pediatric Critical Care Medicine, Tokyo Women's Medical University Yachiyo Medical Center, 477-96 Owadashinden, Yachiyo-shi, Chiba 276-8524, Japan.
| | - Jun-Ichi Takanashi
- Department of Pediatrics, Tokyo Women's Medical University Yachiyo Medical Center, 477-96 Owadashinden, Yachiyo-shi, Chiba 276-8524, Japan.
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Nakajima Y, Kobayashi S, Tanoue H, Ishihara S, Kamiya A, Kawata N, Asakura M, Suzuki D, Obana N, Hayashi K, Kawaguchi T, Noda M, Oba K, Katori T, Kageyama T, Ogasawara M. Cerebral blood flow abnormalities with central sparing on arterial spin labeling in mild encephalopathy associated with excitotoxicity: a case report. BMC Neurol 2022; 22:403. [PMID: 36324091 PMCID: PMC9628096 DOI: 10.1186/s12883-022-02942-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 10/27/2022] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Acute encephalopathy with biphasic seizures and late reduced diffusion (AESD) and mild encephalopathy associated with excitotoxicity (MEEX) are the most frequent acute encephalopathies in pediatric patients in Japan. AESD typically presents with biphasic seizures and delayed reduced diffusion in the subcortical area, called bright tree appearance (BTA), on radiological examination. In patients with AESD, arterial spin labeling (ASL) shows decreased cerebral blood flow (CBF) in the hyperacute stage and increased CBF in the acute stage, suggesting the usefulness of ASL for the early diagnosis of AESD. Additionally, proton magnetic resonance spectroscopy (MRS) shows elevated glutamate (Glu) and glutamine (Gln) in AESD. MEEX is a group of mild encephalopathies with transient elevation of Gln on MRS similar to that in AESD; however, MEEX does not include any clinical biphasic course or abnormalities, including BTA on diffusion-weighted imaging. Although the usefulness of ASL for AESD has been reported, there are no reports for patients with MEEX. In this study, we report our experience with a 4-year-old girl diagnosed with MEEX who showed unique findings on ASL. CASE PRESENTATION The patient was a 4-year-old girl admitted to the emergency room with febrile status epilepticus. Considering the possibility of AESD, vitamin therapy was initiated. ASL-MR imaging (MRI) of the brain performed on the second day showed increased blood flow in the frontal, temporal, and occipital regions with spared central sulcus, which indicated AESD with central sparing. The patient was diagnosed with AESD, and the treatment included pulse steroid therapy and immunoglobulin therapy from day 3. The patient remained mildly unconscious but gradually became conscious by day 7 with no seizures. Brain MRI performed on day 8 did not show any characteristic AESD findings, such as BTA. Furthermore, MRS showed elevated Gln, which, along with the clinical course, led to the diagnosis of MEEX. The patient was discharged on day 16 without obvious sequelae. CONCLUSIONS ASL may be useful in the early diagnosis of MEEX as well as AESD, facilitating early intervention.
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Affiliation(s)
- Yuki Nakajima
- grid.415825.f0000 0004 1772 4742Department of Pediatrics, Showa General Hospital, Tokyo, Japan
| | - Shinya Kobayashi
- grid.415825.f0000 0004 1772 4742Department of Pediatrics, Showa General Hospital, Tokyo, Japan
| | - Hideki Tanoue
- grid.415825.f0000 0004 1772 4742Department of Pediatrics, Showa General Hospital, Tokyo, Japan
| | - Sayaka Ishihara
- grid.415825.f0000 0004 1772 4742Department of Pediatrics, Showa General Hospital, Tokyo, Japan
| | - Ayako Kamiya
- grid.415825.f0000 0004 1772 4742Department of Pediatrics, Showa General Hospital, Tokyo, Japan
| | - Nanako Kawata
- grid.415825.f0000 0004 1772 4742Department of Pediatrics, Showa General Hospital, Tokyo, Japan
| | - Mari Asakura
- grid.415825.f0000 0004 1772 4742Department of Pediatrics, Showa General Hospital, Tokyo, Japan
| | - Daichi Suzuki
- grid.415825.f0000 0004 1772 4742Department of Pediatrics, Showa General Hospital, Tokyo, Japan
| | - Natsuko Obana
- grid.415825.f0000 0004 1772 4742Department of Pediatrics, Showa General Hospital, Tokyo, Japan
| | - Kenta Hayashi
- grid.415825.f0000 0004 1772 4742Department of Pediatrics, Showa General Hospital, Tokyo, Japan
| | - Takahiro Kawaguchi
- grid.415825.f0000 0004 1772 4742Department of Pediatrics, Showa General Hospital, Tokyo, Japan
| | - Masahiro Noda
- grid.415825.f0000 0004 1772 4742Department of Pediatrics, Showa General Hospital, Tokyo, Japan
| | - Kunihiro Oba
- grid.415825.f0000 0004 1772 4742Department of Pediatrics, Showa General Hospital, Tokyo, Japan
| | - Tatsuo Katori
- grid.415825.f0000 0004 1772 4742Department of Pediatrics, Showa General Hospital, Tokyo, Japan
| | - Tsutomu Kageyama
- grid.410795.e0000 0001 2220 1880Center for Emergency Preparedness and Response, National Institute of Infectious Diseases, Tokyo, Japan
| | - Masashi Ogasawara
- grid.415825.f0000 0004 1772 4742Department of Pediatrics, Showa General Hospital, Tokyo, Japan ,grid.419280.60000 0004 1763 8916Department of Neuromuscular Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry (NCNP), 4-1-1 Ogawahigashi, Kodaira, Tokyo, Japan
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Ramji S, McCullagh G, Ram D, Vassallo G, Pavaine J. T2-highlighted U-fibres and rapid parenchymal volume loss in AESD: An under-recognised subtype of paediatric acute encephalopathy syndromes. J Neuroradiol 2020; 47:458-463. [DOI: 10.1016/j.neurad.2019.09.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 08/28/2019] [Accepted: 09/24/2019] [Indexed: 12/23/2022]
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Yamanaka G, Morichi S, Takamatsu T, Takahashi R, Watanabe Y, Ishida Y, Takeshita M, Morishita N, Kasuga A, Kanou K, Oana S, Suzuki S, Go S, Kashiwagi Y, Kawashima H. Granzyme A Participates in the Pathogenesis of Infection-Associated Acute Encephalopathy. J Child Neurol 2020; 35:208-214. [PMID: 31709864 DOI: 10.1177/0883073819886217] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The present study aimed to determine whether granzymes are implicated in the pathogenesis of infection-associated acute encephalopathy (AE). METHODS We investigated granzyme and cytokine levels in the cerebrospinal fluid of patients with acute encephalopathy or complex febrile seizures (cFS). A total of 24 acute encephalopathy patients and 22 complex febrile seizures patients were included in the present study. Levels of granzymes A and B were measured using enzyme-linked immunosorbent assay, and levels of tumor necrosis factor α (TNF-α), interferon-γ (IFN-γ), interleukin 1β (IL-1β), IL-1 receptor antagonist (IL-1RA), IL-4, IL-6, IL-8, and IL-10 were assessed using the Bio-Plex suspension array system. RESULTS Cerebrospinal fluid levels of granzyme A were significantly higher, and those of TNF-α and IL-1RA were significantly lower in the AE group than in the cFS group; however, no significant differences in the levels of granzyme B, IFN-γ, IL-1β, IL-4, IL-6, IL-8, and IL-10 were observed between the 2 groups. In addition, no significant differences in granzyme A, granzyme B, or cytokine levels were observed between acute encephalopathy patients with and those without neurologic sequelae. CONCLUSIONS Our findings indicate the involvement of granzyme A in the pathogenesis of acute encephalopathy.
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Affiliation(s)
- Gaku Yamanaka
- Department of Pediatrics and Adolescent Medicine, Tokyo Medical University, Shinjuku, Tokyo, Japan
| | - Shinichiro Morichi
- Department of Pediatrics and Adolescent Medicine, Tokyo Medical University, Shinjuku, Tokyo, Japan
| | - Tomoko Takamatsu
- Department of Pediatrics and Adolescent Medicine, Tokyo Medical University, Shinjuku, Tokyo, Japan
| | - Ryou Takahashi
- Department of Pediatrics and Adolescent Medicine, Tokyo Medical University, Shinjuku, Tokyo, Japan
| | - Yusuke Watanabe
- Department of Pediatrics and Adolescent Medicine, Tokyo Medical University, Shinjuku, Tokyo, Japan
| | - Yu Ishida
- Department of Pediatrics and Adolescent Medicine, Tokyo Medical University, Shinjuku, Tokyo, Japan
| | - Mika Takeshita
- Department of Pediatrics and Adolescent Medicine, Tokyo Medical University, Shinjuku, Tokyo, Japan
| | - Natsumi Morishita
- Department of Pediatrics and Adolescent Medicine, Tokyo Medical University, Shinjuku, Tokyo, Japan
| | - Akiko Kasuga
- Department of Pediatrics and Adolescent Medicine, Tokyo Medical University, Shinjuku, Tokyo, Japan
| | - Kanako Kanou
- Department of Pediatrics and Adolescent Medicine, Tokyo Medical University, Shinjuku, Tokyo, Japan
| | - Singo Oana
- Department of Pediatrics and Adolescent Medicine, Tokyo Medical University, Shinjuku, Tokyo, Japan
| | - Shunsuke Suzuki
- Department of Pediatrics and Adolescent Medicine, Tokyo Medical University, Shinjuku, Tokyo, Japan
| | - Soken Go
- Department of Pediatrics and Adolescent Medicine, Tokyo Medical University, Shinjuku, Tokyo, Japan
| | - Yasuyo Kashiwagi
- Department of Pediatrics and Adolescent Medicine, Tokyo Medical University, Shinjuku, Tokyo, Japan
| | - Hisashi Kawashima
- Department of Pediatrics and Adolescent Medicine, Tokyo Medical University, Shinjuku, Tokyo, Japan
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MR spectroscopy even has power to predict outcome of acute encephalopathy. J Neurol Sci 2020; 408:116637. [DOI: 10.1016/j.jns.2019.116637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 12/14/2019] [Indexed: 11/17/2022]
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Takanashi JI, Murofushi Y, Hirai N, Sano K, Matsuo E, Saito K, Yasukawa K, Hamada H. Prognostic value of MR spectroscopy in patients with acute excitotoxic encephalopathy. J Neurol Sci 2019; 408:116636. [PMID: 31879119 DOI: 10.1016/j.jns.2019.116636] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 11/25/2019] [Accepted: 12/14/2019] [Indexed: 02/03/2023]
Abstract
PURPOSE Acute excitotoxic encephalopathy is the most common encephalopathy syndrome in Japan, and consists of acute encephalopathy with biphasic seizures and late reduced diffusion (AESD) and mild encephalopathy associated with excitotoxicity (MEEX). Neurological sequelae remain in approximately 70% of patients with AESD, however, it is difficult to predict the prognosis early in the course. We evaluated the brain metabolites observed on MRS as to whether they can predict the neurological outcome. METHODS 16 previously healthy Japanese patients with excitotoxic encephalopathy (8 with AESD and 8 with MEEX) were included in this study. MR spectroscopy (MRS) was acquired from the fronto-parietal white matter (TR/TE = 5000/30 msec) with a 3.0 T scanner. Quantification of metabolites was performed using an LCModel. Neurological outcome was assessed with the Pediatric Cerebral Performance Category score, score 1 being classified as G1 (normal), scores 2 and 3 as G2 (mild to moderate), and scores 4-6 as G3 (severe). RESULTS MRS data which predict a poor neurological outcome (G2 and 3) include the following: decreased N-acetyl aspartate (NAA) (sensitivity 88%, specificity 100%), decreased creatine (47%, 100%), increased lactate (47%, 100%), and decreased glutamate (sensitivity 35%, specificity 100%). Limited to the acute stage within seven days of onset, those for a poor prognosis are as follows, decreased NAA (88%, 100%), decreased creatine (38%, 100%), and increased lactate (38%, 100%). CONCLUSION MRS is useful for prognosis prediction of acute excitotoxic encephalopathy. Decreased NAA will be the most effective metabolite for neurological prognosis prediction.
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Affiliation(s)
- Jun-Ichi Takanashi
- Department of Pediatrics, Tokyo Women's Medical University Yachiyo Medical Center, Yachiyo, Japan.
| | - Yuka Murofushi
- Department of Pediatrics, Tokyo Women's Medical University Yachiyo Medical Center, Yachiyo, Japan
| | - Nozomi Hirai
- Department of Pediatrics, Tokyo Women's Medical University Yachiyo Medical Center, Yachiyo, Japan
| | - Kentaro Sano
- Department of Pediatrics, Tokyo Women's Medical University Yachiyo Medical Center, Yachiyo, Japan
| | - Emiyu Matsuo
- Department of Pediatrics, Tokyo Women's Medical University Yachiyo Medical Center, Yachiyo, Japan
| | - Keito Saito
- Department of Medical Technology and Image Laboratory, Tokyo Women's Medical University Yachiyo Medical Center, Yachiyo, Japan
| | - Kumi Yasukawa
- Department of Pediatrics, Tokyo Women's Medical University Yachiyo Medical Center, Yachiyo, Japan
| | - Hiromichi Hamada
- Department of Pediatrics, Tokyo Women's Medical University Yachiyo Medical Center, Yachiyo, Japan
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