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AJNR - American Journal of Neuroradiology

Published ahead of print on August 13, 2008
doi: 10.3174/ajnr.A1247

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American Journal of Neuroradiology 30:132-135, January 2009
© 2009 American Society of Neuroradiology

Case Report
PEDIATRICS

Excitotoxicity in Acute Encephalopathy with Biphasic Seizures and Late Reduced Diffusion

J. Takanashi^a, H. Tada^a, H. Terada^b and A.J. Barkovich^c

^a Department of Pediatrics, Kameda Medical Center, Kamogawa, Japan
^b Department of Radiology, Toho University Sakura Medical Center, Sakura, Japan
^c Neuroradiology Section, Department of Radiology, University of California, San Francisco, San Francisco, Calif

Please address correspondence to Jun-ichi Takanashi, MD, Department of Pediatrics, Kameda Medical Center, 929 Higashi-cho, Kamogawa-shi, Chiba 296-8602, Japan; e-mail: jtaka{at}kameda.jp

SUMMARY: Acute encephalopathy with biphasic seizures and late reduced diffusion (AESD) is a recently described clinicoradiologic syndrome. MR spectroscopy in 3 patients with AESD revealed decreased N-acetylaspartate (NAA) and elevated glutamine/glutamate complex (Glx) during the week of presentation. Afterward, Glx normalized, whereas NAA remained low in 2 patients with neurologic sequelae but nearly normalized in the third patient without neurologic sequelae. These findings support the hypothesis that excitotoxic neuronal damage plays an important role in the pathogenesis of AESD and suggest that MR spectroscopy might be predictive of outcome.

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