Increased volume of cerebral oedema is associated with risk of acute seizure activity and adverse neurological outcomes in encephalitis – regional and volumetric analysis in a multi-centre cohort

BMC Neurology

Research

Jian P. K. Chen¹  Ali M. Alam²  Greta K. Wood²  Benedict D. Michael³  Tom Solomon³  Sylviane Defres⁴  Maneesh Bhojak⁵  Kumar Das⁵  Simon S. Keller⁶  Bethany Facer⁶  Anthony Marson⁷  Julia Granerod⁸  Rhys H. Thomas⁹  David Brown^1,10 

[1] Barts Health NHS Trust, London, UK;Department of Clinical Infection Microbiology and Immunology, Institute of Infection, Veterinary, and Ecological Science, University of Liverpool, Liverpool, UK;The NIHR Health Protection Research Unit for Emerging and Zoonotic Infection, Liverpool, UK;Department of Clinical Infection Microbiology and Immunology, Institute of Infection, Veterinary, and Ecological Science, University of Liverpool, Liverpool, UK;The NIHR Health Protection Research Unit for Emerging and Zoonotic Infection, Liverpool, UK;Department of Neurology, The Walton Centre NHS Foundation Trust, Liverpool, UK;Department of Clinical Infection Microbiology and Immunology, Institute of Infection, Veterinary, and Ecological Science, University of Liverpool, Liverpool, UK;The NIHR Health Protection Research Unit for Emerging and Zoonotic Infection, Liverpool, UK;Tropical and Infectious Diseases Unit, Liverpool University Hospitals NHS Trust, Liverpool, UK;Department of Neuroradiology, The Walton Centre NHS Foundation Trust, Liverpool, UK;Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK;Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK;Department of Neurology, The Walton Centre NHS Foundation Trust, Liverpool, UK;Independent Scientific Consultant, formerly of Public Health England, London, UK;Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK;UK Heath Security Agency, 61 Colindale Avenue, London, UK;

关键词: Encephalitis;    Acute encephalitis syndrome;    Seizures;    Magnetic resonance imaging;    Neuroimaging;   

DOI  :  10.1186/s12883-022-02926-5

 received in 2022-07-22, accepted in 2022-10-17,  发布年份 2022

来源: Springer

【 摘 要 】

BackgroundSeizures can occur unpredictably in patients with acute encephalitis syndrome (AES), and many suffer from poor long-term neurological sequelae. Establishing factors associated with acute seizures risk and poor outcomes could support clinical care. We aimed to conduct regional and volumetric analysis of cerebral oedema on magnetic resonance imaging (MRI) in patients with AES. We assessed the relationship of brain oedema with acute seizure activity and long-term neurological outcome.MethodsIn a multi-centre cohort study, adults and children presenting with an AES were recruited in the UK. The clinical and brain MRI data were retrospectively reviewed. The outcomes variables were inpatient acute seizure activity and neurological disability at six-months post-discharge. A poor outcome was defined as a Glasgow outcome score (GOS) of 1–3. We quantified regional brain oedema on MRI through stereological examination of T2-weighted images using established methodology by independent and blinded assessors. Clinical and neuroimaging variables were analysed by multivariate logistic regression to assess for correlation with acute seizure activity and outcome.ResultsThe study cohort comprised 69 patients (mean age 31.8 years; 53.6% female), of whom 41 (59.4%) had acute seizures as inpatients. A higher Glasgow coma scale (GCS) score on admission was a negative predictor of seizures (OR 0.61 [0.46–0.83], p = 0.001). Even correcting for GCS on admission, the presence of cortical oedema was a significant risk factor for acute seizure activity (OR 5.48 [1.62–18.51], p = 0.006) and greater volume of cerebral oedema in these cortical structures increased the risk of acute seizures (OR 1.90 [1.12–3.21], p = 0.017). At six-month post-discharge, 21 (30.4%) had a poor neurological outcome. Herpes simplex virus encephalitis was associated with higher risk of poor outcomes in univariate analysis (OR 3.92 [1.08–14.20], p = 0.038). When controlling for aetiology, increased volume of cerebral oedema was an independent risk factor for adverse neurological outcome at 6 months (OR 1.73 [1.06–2.83], p = 0.027).ConclusionsBoth the presence and degree of cerebral oedema on MRIs of patients with AES may help identify patients at risk of acute seizure activity and subsequent long-term morbidity.

【 授权许可】

CC BY   
© The Author(s) 2022. corrected publication 2022

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