A reversible lesion of the corpus callosum splenium with adult influenza-associated encephalitis/encephalopathy: a case report

<p>ABstract</p> <p>Introduction</p> <p>Influenza virus-associated encephalitis/encephalopathy is a severe childhood illness with a poor prognosis. Adult case reports are rare and, to date, there have been no reports of adults with a mild subcortical encephalopathy with reversible lesions of the corpus callosum splenium.</p> <p>Case presentation</p> <p>A previously healthy 35-year-old man presented with acute progressive tetraplegia, transcortical motor aphasia and a mild decrease in his consciousness during his recovery after receiving oseltamivir phosphate treatment, and influenza type A antiviral medication. The initial magnetic resonance imaging study at day 1 showed symmetrical diffuse lesions in the white matter and a lesion on the central portion of the corpus callosum splenium. These findings had resolved on follow-up studies at day 8 and day 146. His neurological deficits mostly recovered within 12 hours following methylprednisolone pulse therapy. The levels of interleukin-6 and interleukin-10 in his blood and cerebrospinal fluid were initially elevated, but rapidly decreased to normal levels by day 8.</p> <p>Conclusion</p> <p>It is important for clinicians to recognize that even in adulthood, the subcortical encephalopathy observed during the therapeutic treatment for influenza type A infection can occur in conjunction with a reversible lesion of the corpus callosum, which may recover quickly. In addition, the cytokine storm in the blood system and the corticospinal cavity may play an important role in the etiology of the disease process.</p

Gastric myoelectrical activities in elderly severe tetanus: Useful marker to increase volume and calorie of nasogastric tube feeding

Background & aims: Early high nasogastric tube feeding (NTF) is effective for improving the nutritional status of critical illness. However, potential complications of NTF in tetanus include aspiration pneumonia because of dysphagia and gastrointestinal dysfunction induced by over-activity of autonomic nervous system. Methods: We serially evaluated gastric myoelectrical activities using electrogastrogram (EGG) recorder in 4 elderly severe tetanus patients, and assessed its potential as a marker to increase volume and calorie of NTF. Results: Although dominant frequencies of EGG in all patients (1.8 ± 0.6 cycle/min (cpm)) were lower than those in healthy volunteers (2.9 ± 0.2 cpm) at least until 12th hospital day, it tended to improve from 14-24th hospital day and reached the same levels in healthy volunteers at least until 28th hospital day. We transferred total NTF along their metabolic costs when the timing of dominant frequency tended to improve in each patient (17-24th hospital day). No aspiration pneumonia and malnutrition occurred in their hospital days. Conclusion: EGG data may be a useful marker to know the level of over-activity of autonomic nervous system and to guess the best timing to increase volume and calorie of NTF especially in elderly severe tetanus