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AJNR - American Journal of Neuroradiology

Publication Preview: Published August 13, 2008

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American Journal of Neuroradiology
DOI 10.3174/ajnr.A1247

PEDIATRICS

Excitotoxicity in Acute Encephalopathy with Biphasic Seizures and Late Reduced Diffusion

J. Takanashi, H. Tada, H. Terada and A.J. Barkovich

From the Department of Pediatrics (J.T., H.T.), Kameda Medical Center, Kamogawa, Japan; Department of Radiology (H.T.), Toho University Sakura Medical Center, Sakura, Japan; and Neuroradiology Section (A.J.B.), 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.