Recovery without Neurological Sequelae in Fulminant Cerebral Edema in Pediatric Encephalitis with Human Herpesvirus Type 6
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Viral encephalitis can lead to serious neurological sequelae and death among younger children. It is also known that the mortality rate in encephalitis with cerebral edema or transtentorial brain herniation is higher. A 4-year-old boy visited our emergency department exhibiting mental change. The patient had a high fever for four and a whole-body rash for three days prior to his visit. He had displayed irritable symptoms and been vomiting for six hours before his visit, accompanied by seizure. After 13 hours of admission, the patient’s right pupil became fixed and fully dilated, and the left pupil also became fixed and fully dilated within 30 minutes. Brain computed tomography (CT) was performed immediately, and severe brain swelling with transtentorial brain herniation was found. The mannitol dose was increased and dexamethasone was also added. Hyperventilation was performed through intubation to reach PaCO2 levels of 25 to 30mmHg. Fifteen hours later, pupillary reflex was observed and the cerebral edema and transtentorial brain herniation was found to be improving in follow-up brain CT. He was transferred to a general ward after 11 days and discharged on the thirteenth hospital day without any neurological sequelae. Human herpesvirus type 6 (HHV-6) was detected in the serological polymerase chain reaction (PCR) examination.
Abstract
Viral encephalitis can lead to serious neurological sequelae and death among younger children. It is also known that the mortality rate in encephalitis with cerebral edema or transtentorial brain herniation is higher. A 4-year-old boy visited our emergency department exhibiting mental change. The patient had a high fever for four and a whole-body rash for three days prior to his visit. He had displayed irritable symptoms and been vomiting for six hours before his visit, accompanied by seizure. After 13 hours of admission, the patient’s right pupil became fixed and fully dilated, and the left pupil also became fixed and fully dilated within 30 minutes. Brain computed tomography (CT) was performed immediately, and severe brain swelling with transtentorial brain herniation was found. The mannitol dose was increased and dexamethasone was also added. Hyperventilation was performed through intubation to reach PaCO2 levels of 25 to 30mmHg. Fifteen hours later, pupillary reflex was observed and the cerebral edema and transtentorial brain herniation was found to be improving in follow-up brain CT. He was transferred to a general ward after 11 days and discharged on the thirteenth hospital day without any neurological sequelae. Human herpesvirus type 6 (HHV-6) was detected in the serological polymerase chain reaction (PCR) examination.
참고문헌 (15)
- Tunkel AR, "The management of encephalitis: clinical practice guidelines by the infectious diseases society of America", Clin Infect Dis, 47, pp.303~327 (2008)[DOI]
- Khandaker G, "Longterm outcomes of infective encephalitis in children: a systematic review and meta-analysis", Dev Med Child Neurol, 58, pp.1108~1115 (2016)[DOI]
- Koskiniemi M, "Epidemiology of encephalitis in children. A prospective multicenter study", Eur J Pediatr, 156, pp.541~545 (1996)
- Bale JF Jr, "Virus and immune-mediated encephalitides: epidemiology, diagnosis, treatment, and prevention", Pediatr Neurol, 53, pp.3~12 (2015)[DOI]
- Marcdante KJ, "Nelson Essentials of Pediatrics", pp.344~346 (2015), Saunders
- Sasaki J, "Outcome of children with acute encephalitis and refractory status epilepticus", J Child Neurol, 29, pp.1638~1644 (2014)[DOI]
- Lan SY, "Analysis of fulminant cerebral edema in acute pediatric encephalitis", Pediatr Neonatol, 57, pp.402~407 (2016)[DOI]
- Battey TW, "Brain edema predicts outcome after nonlacunar ischemic stroke", Stroke, 45, pp.3643~3648 (2014)[DOI]
- Kinoshita K, "Traumatic brain injury: pathophysiology for neurocritical care", J Intensive Care, 4, pp.29~ (2016)[DOI]
- Glaser CA, "Beyond viruses: clinical profiles and etiologies associated with encephalitis", Clin Infect Dis, 43, pp.1565~1577 (2006)[DOI]
- Mannonen L, "Primary human herpesvirus-6 infection in the central nervous system can cause severe disease", Pediatr Neurol, 37, pp.186~191 (2007)[DOI]
- Crawford JR, "Human herpesvirus 6 rhombencephalitis in immunocompetent children", J Child Neurol, 22, pp.1260~1268 (2007)[DOI]
- 조성민, "경련지속상태 후 뇌사에 이른 환아의 뇌척수액에서 발견된 human herpesvirus-6 (HHV-6)", 대한소아신경학회지, 20(3), pp.196~200 (2012), 대한소아신경학회
- Ward KN, "Human herpesvirus 6 DNA levels in cerebrospinal fluid due to primary infection differ from those due to chromosomal viral integration and have implications for diagnosis of encephalitis", J Clin Microbiol, 45, pp.1298~1304 (2007)[DOI]
- Koskiniemi M, "Handbook of neurovirology", pp.131~140 (1994), Marcel Dekker, Inc.