Reversible splenial lesion syndrome in children with benign convulsions associated with mild gastroenteritis: A retrospective study of five cases.

OBJECTIVE: To assess the clinical and imaging features of reversible splenial lesion syndrome (RESLES) with benign convulsions associated with mild gastroenteritis (CwG) in children. PATIENTS AND METHODS: We retrospectively reviewed the clinical course, blood and stool examinations, cerebrospinal fluid (CSF) examination, magnetic resonance imaging (MRI), electroencephalography (EEG) findings, therapy and prognosis of five children with RESLES associated with CwG. RESULTS: Five previously healthy patients, four girls and one boy, with mean age 26.4 ±â€¯8.1 months, had clusters of general tonic-clonic or clonic seizures within the first two days of gastroenteritis. Rotavirus antigen was positive in the stool of one case. Interictal EEG was normal except in one case, which showed occipital slow wave. The initial MRI was performed within five days of onset, four patients had an isolated lesion in the splenium of the corpus callosum (SCC), and one patient had lesions extending outside the SCC that involved the genu of the corpus callosum. The follow-up MRI was performed 10-15 days after onset, and all lesions had completely disappeared. All patients were treated with antiviral, rehydration and anticonvulsant therapy in the acute phase. They had good prognosis and normal psychomotor development, with no neurological sequelae after 26-30 months of follow-up. CONCLUSIONS: CwG and RESLES can coexist in young children. The patients present with clusters of general tonic-clonic or clonic seizures in the acute phase. Brain MRI shows focal lesion in the SCC with high signal intensity on T2-weighted and FLAIR sequences. It has good prognosis and excessive treatment is not necessary.

Case report: detection of rotavirus RNA in the cerebrospinal fluid of a child with rotavirus gastroenteritis and meningism.

Although case reports have described detection of rotavirus (RV) in extraintestinal sites such as the liver, kidney, and central nervous system (CNS) of children with RV gastroenteritis, CNS localization in RV infection seems to be rare. RT-PCR and nucleotide sequencing detected a G1P[8] strain in the stool and cerebrospinal fluid (CSF) samples of a patient with concurrent RV-associated enteritis and CNS signs. Upon sequence analysis, the viruses detected in the CSF was identical to the virus detected in the stools. In the VP7- and VP4-based phylogenetic dendograms the strain clustered within the G1-Ic sub-lineage and the P[8]-III lineage. This study supports the hypothesis that RV infection was able to spread from the intestinal tract to the CNS, and likely played a role in the onset of neurological disease.

CSF levels of carnitine in children with meningitis, neurologic disorders, acute gastroenteritis, and seizure.

Carnitine concentrations in CSF, serum, and urine in normal febrile children and children with meningitis, neurologic disorders, and dehydration were studied. Carnitine levels in CSF were 1/10 compared with serum in normal febrile children. These levels increased two- to three-fold in the pathologic conditions studied. Since damage to the blood-brain barrier occurs in these conditions, higher blood-brain barrier permeability might explain CNS carnitine accumulation.

Detection of rotavirus in cerebrospinal fluid and blood of patients with convulsions and gastroenteritis by means of the reverse transcription polymerase chain reaction.

Rotavirus RNA was detected in the blood and cerebrospinal fluid from eight Japanese children with convulsions and gastroenteritis in the acute stage by means of the reverse transcription polymerase chain reaction. This may suggest that rotavirus invades the central nervous system through blood vessels.

Augmented production of interleukin-8 in cerebrospinal fluid in bacterial meningitis.

Interleukin-8 (IL-8) elaborated by monocytes and endothelial cells is a cytokine which is responsible for adhesion of leucocytes to vascular endothelium and migration of neutrophils into the cerebrospinal fluid (CSF) from the intravascular space. The inflammation in meningitis is elicited by the cytokine release from leucocytes which encounter micro-organisms in the arachnoid or subarachnoid space. In bacterial meningitis, tumour necrosis factor (TNF), IL-1 and IL-6 are produced vigorously, and initiate and augment the inflammation in the central nervous system. In this study, utilizing a quantitative immunometric sandwich enzyme immunoassay, the concentration of IL-8 was investigated in the CSF of patients with bacterial meningitis, patients with aseptic meningitis, and patients with gastroenteritis who served as controls. The IL-8 concentration was markedly higher in the CSF of patients with bacterial meningitis (224 +/- 2.57 pg/ml; mean +/- SD) than in the CSF of patients with aseptic meningitis (less than 30 pg/ml). The IL-8 level in the CSF of patients with aseptic meningitis did not differ from that in the CSF of the patients with gastroenteritis (less than 30 pg/ml). The augmented production of IL-8 in CSF may account for the inflammation in bacterial meningitis being more severe than that in aseptic meningitis.

Anti-rotavirus antibody in cerebrospinal fluid.

Ten infants with benign convulsions associated with rotavirus gastroenteritis had no specific antibodies in cerebrospinal fluid by enzyme linked immunosorbent assay (ELISA). On the other hand, eight of 173 patients with other neurological diseases had specific IgG, IgA, or IgM antibodies. The reason for positive ELISA results is discussed.

Immunoassays for the diagnosis of viral enteric pathogens.

The accurate diagnosis of infectious diseases is important for the optimal management of infected patients as well as for the prevention of disease transmission to susceptible individuals. Because viral gastroenteritis constitutes an important cause of morbidity in children living in developed countries and of mortality in children living in developing countries, there has been a great deal of interest in the development of effective methods for the diagnosis and study of this disease. While there are a number of assay systems that are capable of accurate detection of the agents of viral gastroenteritis in the intestinal contents of infected individuals, solid phase enzyme immunoassays have been used widely for this purpose. The widespread utilization of enzyme immunoassays is based on the advantages inherent in the use of enzymatic markers. These advantages include the stability of enzyme-immunoglobulin conjugates, the high degree of sensitivity inherent in the magnifying nature of enzyme-substrate interactions, and the low cost of assays performed in simple reaction formats. Enzyme immunoassays have thus been developed and widely used for the detection and epidemiologic study of rotaviruses, adenoviruses, coxsackie viruses, hepatitis A virus, and other agents that replicate in the human gastrointestinal tract. In addition, latex agglutination assays and nucleic acid hybridization techniques have been applied to the rapid detection of enteric viruses. It is likely that the application of a number of assay systems will promote accurate identification of a wide range of viral pathogens under different clinical, epidemiologic, and laboratory situations.

Acid base balance in blood and cerebrospinal fluid.

Thirty four infants were studied; 21 with acute gastroenteritis, dehydration, and metabolic acidosis and 13 who served as controls. All infants with metabolic acidosis and without neurological signs had a normal to near normal cerebrospinal fluid acid base balance, but five with metabolic acidosis and severe neurological signs had cerebrospinal fluid acid base disequilibrium. Acute metabolic acidosis in infants may lead to cerebrospinal fluid acid base imbalance causing cerebral dysfunction.