Vascular pathomechanism in acute encephalopathy with biphasic seizures and late reduced diffusion

Acute encephalopathy with biphasic seizures and late reduced diffusion (AESD) is a childhood-onset encephalopathy, but the precise pathophysiology remains unclear. We encountered a child with Moyamoya syndrome and AESD. He exhibited left-predominant stenosis of the middle cerebral artery (MCA), and...

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Bibliographic Details
Published in:Journal of the neurological sciences 2018-12, Vol.395, p.141-146
Main Authors: Sanefuji, Masafumi, Ichimiya, Yuko, Kaku, Noriyuki, Sasazuki, Momoko, Yonemoto, Kosuke, Torio, Michiko, Mizuguchi, Soichi, Motomura, Yoshitomo, Muraoka, Mamoru, Lee, Sooyoung, Baba, Haruhisa, Ohkubo, Kazuhiro, Sonoda, Yuri, Ishizaki, Yoshito, Sakai, Yasunari, Ohga, Shouichi
Format: Article
Language:English
Subjects:
Acute encephalopathy
Apparent diffusion coefficient
Cerebral blood flow
Child
Diffusion weighed image
Magnetic resonance angiography
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Summary:Acute encephalopathy with biphasic seizures and late reduced diffusion (AESD) is a childhood-onset encephalopathy, but the precise pathophysiology remains unclear. We encountered a child with Moyamoya syndrome and AESD. He exhibited left-predominant stenosis of the middle cerebral artery (MCA), and later developed broad lesions in the left hemisphere, raising the possibility that insufficient blood supply relates to formation of the lesions. To test the hypothesis, we investigated the relationship between MCA volume and lesion extent in seven AESD children without preexisting diseases. The MCA volume and lesion extent were quantified with time of flight images for construction of magnetic resonance angiography and apparent diffusion coefficient maps, respectively. Lateralization indices ([right − left]/[right + left]) of the MCA volume and lesion extent were calculated. We found that the lateralization indices were negatively correlated (r = −0.786, p = .036), that is, when the MCA volume was smaller in one side than the other side, the lesions were likely to develop more extensively in the ipsilateral side than the contralateral side. This indicates the association of insufficient blood supply with the lesions. The present study provides the first observation to suggest the involvement of vascular mechanism in AESD and has potential implications for novel therapeutic approach. •Acute encephalopathy with biphasic seizures and late reduced diffusion (AESD)•Arterial stenosis related to broad lesions in an AESD child with Moyamoya syndrome.•The association of arterial volume with lesion extent was validated in 7 patients.•Insufficient blood supply via vascular mechanism may produce the lesions of AESD.
ISSN:0022-510X
1878-5883
DOI:10.1016/j.jns.2018.10.007