Hemispheric AESD: Half-Bright Tree Appearance in a Child With Hepatitis A

摘要

A previously healthy, 3-year-old girl developed acute-onset high-grade fever, jaundice, and irritability over the past 2 weeks followed by recurrent, generalized tonic-clonic seizures and encephalopathy. Developmental and family history was unremarkable. On examination, she had pallor, icterus, hepatosplenomegaly (liver span 10 cm), encephalopathy, generalized hypotonia, brisk muscle stretch reflexes, bilateral Babinski sign, acral dyskinesia, and normal fundi. Investigations showed anemia (hemoglobin 61 g/L), conjugated hyper-bilirubinemia (4.99 mg/dL), transaminitis (aspartate aminotransferases 1237 IU/L, alanine aminotransferases 772 IU/L), coagulopathy, hyperammonemia (141 umol/L), elevated arterial lactate (2.5 umol/L), hepatitis A seropositiv-ity, and normal cerebrospinal fluid analysis. Neuroimaging showed hemispheric form of acute encephalopathy with biphasic seizures and late reduced diffusion (AESD; Figure 1A and B). She recovered with supportive care and protein restriction with no recurrence of seizures or encephalopathy. Repeat neuroimaging (Figure 1C and D) showed complete resolution of abnormalities.