Infantile Hypoxic Encephalopathy Mimicking Acute Encephalopathy with Biphasic Seizures and Late Reduced Diffusion (AESD) Identified as an Episode of Brief Resolved Unexplained Event (BRUE)
Acute encephalopathy with biphasic seizures and reduced diffusion (AESD) is characterized by biphasic seizures following febrile viral infections and delayed reduced diffusion of the cerebral white matter on magnetic resonance imaging (MRI) diffusion-weighted imaging (DWI) (bright tree appearance, B...
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MDPI AG
2023-08-01
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| Series: | Journal of Clinical Medicine |
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| Online Access: | https://www.mdpi.com/2077-0383/12/16/5239 |
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| author | Shuhei Fujino Mikako Enokizono Tatsuo Kono Sahoko Miyama |
| author_facet | Shuhei Fujino Mikako Enokizono Tatsuo Kono Sahoko Miyama |
| author_sort | Shuhei Fujino |
| collection | DOAJ |
| description | Acute encephalopathy with biphasic seizures and reduced diffusion (AESD) is characterized by biphasic seizures following febrile viral infections and delayed reduced diffusion of the cerebral white matter on magnetic resonance imaging (MRI) diffusion-weighted imaging (DWI) (bright tree appearance, BTA). However, hypoxic encephalopathy with biphasic seizures and AESD-mimicking imaging findings has not been reported. We report a case of hypoxic encephalopathy due to suffocation with concomitant biphasic seizures and BTA, mimicking AESD. On day 1, a healthy 5-month-old girl was found face down with decreased breathing and a deteriorating consciousness level, suggesting a brief resolved unexplained event (BRUE). Electroencephalography (EEG) revealed periodic epileptic discharges, suggesting possible nonconvulsive status epilepticus. Despite improvements in consciousness level and EEG abnormalities on day 2, her consciousness level deteriorated again with generalized tonic–clonic seizures on day 3, and a head MRI-DWI revealed restricted diffusion predominantly in the subcortical areas, suggesting BTA. Treatment for acute encephalopathy resolved the clinical seizures and EEG abnormalities. Persistence of abnormal EEG, reflecting abnormal excitation and accumulation of neurotoxic substances caused by hypoxia, may have contributed to the development of AESD-like findings. As hypoxic encephalopathy causes AESD-like biphasic seizures, monitoring consciousness level, seizure occurrence, and EEG abnormalities even after acute symptoms have temporarily improved following hypoxia is essential. |
| first_indexed | 2024-03-10T23:51:02Z |
| format | Article |
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| institution | Directory Open Access Journal |
| issn | 2077-0383 |
| language | English |
| last_indexed | 2024-03-10T23:51:02Z |
| publishDate | 2023-08-01 |
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| record_format | Article |
| series | Journal of Clinical Medicine |
| spelling | doaj.art-fe71669fc4114ab8b414b36e00152bcc2023-11-19T01:40:08ZengMDPI AGJournal of Clinical Medicine2077-03832023-08-011216523910.3390/jcm12165239Infantile Hypoxic Encephalopathy Mimicking Acute Encephalopathy with Biphasic Seizures and Late Reduced Diffusion (AESD) Identified as an Episode of Brief Resolved Unexplained Event (BRUE)Shuhei Fujino0Mikako Enokizono1Tatsuo Kono2Sahoko Miyama3Department of Neurology, Tokyo Metropolitan Children’s Medical Center, Tokyo 183-8561, JapanDepartment of Radiology, Tokyo Metropolitan Children’s Medical Center, Tokyo 183-8561, JapanDepartment of Radiology, Tokyo Metropolitan Children’s Medical Center, Tokyo 183-8561, JapanDepartment of Neurology, Tokyo Metropolitan Children’s Medical Center, Tokyo 183-8561, JapanAcute encephalopathy with biphasic seizures and reduced diffusion (AESD) is characterized by biphasic seizures following febrile viral infections and delayed reduced diffusion of the cerebral white matter on magnetic resonance imaging (MRI) diffusion-weighted imaging (DWI) (bright tree appearance, BTA). However, hypoxic encephalopathy with biphasic seizures and AESD-mimicking imaging findings has not been reported. We report a case of hypoxic encephalopathy due to suffocation with concomitant biphasic seizures and BTA, mimicking AESD. On day 1, a healthy 5-month-old girl was found face down with decreased breathing and a deteriorating consciousness level, suggesting a brief resolved unexplained event (BRUE). Electroencephalography (EEG) revealed periodic epileptic discharges, suggesting possible nonconvulsive status epilepticus. Despite improvements in consciousness level and EEG abnormalities on day 2, her consciousness level deteriorated again with generalized tonic–clonic seizures on day 3, and a head MRI-DWI revealed restricted diffusion predominantly in the subcortical areas, suggesting BTA. Treatment for acute encephalopathy resolved the clinical seizures and EEG abnormalities. Persistence of abnormal EEG, reflecting abnormal excitation and accumulation of neurotoxic substances caused by hypoxia, may have contributed to the development of AESD-like findings. As hypoxic encephalopathy causes AESD-like biphasic seizures, monitoring consciousness level, seizure occurrence, and EEG abnormalities even after acute symptoms have temporarily improved following hypoxia is essential.https://www.mdpi.com/2077-0383/12/16/5239acute encephalopathy with biphasic seizures and late reduced diffusionhypoxic encephalopathybrief resolved unexplained eventbright tree appearanceglutamate excitotoxicitynonconvulsive status epilepticus |
| spellingShingle | Shuhei Fujino Mikako Enokizono Tatsuo Kono Sahoko Miyama Infantile Hypoxic Encephalopathy Mimicking Acute Encephalopathy with Biphasic Seizures and Late Reduced Diffusion (AESD) Identified as an Episode of Brief Resolved Unexplained Event (BRUE) Journal of Clinical Medicine acute encephalopathy with biphasic seizures and late reduced diffusion hypoxic encephalopathy brief resolved unexplained event bright tree appearance glutamate excitotoxicity nonconvulsive status epilepticus |
| title | Infantile Hypoxic Encephalopathy Mimicking Acute Encephalopathy with Biphasic Seizures and Late Reduced Diffusion (AESD) Identified as an Episode of Brief Resolved Unexplained Event (BRUE) |
| title_full | Infantile Hypoxic Encephalopathy Mimicking Acute Encephalopathy with Biphasic Seizures and Late Reduced Diffusion (AESD) Identified as an Episode of Brief Resolved Unexplained Event (BRUE) |
| title_fullStr | Infantile Hypoxic Encephalopathy Mimicking Acute Encephalopathy with Biphasic Seizures and Late Reduced Diffusion (AESD) Identified as an Episode of Brief Resolved Unexplained Event (BRUE) |
| title_full_unstemmed | Infantile Hypoxic Encephalopathy Mimicking Acute Encephalopathy with Biphasic Seizures and Late Reduced Diffusion (AESD) Identified as an Episode of Brief Resolved Unexplained Event (BRUE) |
| title_short | Infantile Hypoxic Encephalopathy Mimicking Acute Encephalopathy with Biphasic Seizures and Late Reduced Diffusion (AESD) Identified as an Episode of Brief Resolved Unexplained Event (BRUE) |
| title_sort | infantile hypoxic encephalopathy mimicking acute encephalopathy with biphasic seizures and late reduced diffusion aesd identified as an episode of brief resolved unexplained event brue |
| topic | acute encephalopathy with biphasic seizures and late reduced diffusion hypoxic encephalopathy brief resolved unexplained event bright tree appearance glutamate excitotoxicity nonconvulsive status epilepticus |
| url | https://www.mdpi.com/2077-0383/12/16/5239 |
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