Table 1.
Clinical information of adult-onset ANE in 13 patients.
| Age/Sex | Clinical symptoms & signs | Laboratory findings |
Characteristic finding of images |
Treatment | Outcome | Reference | |||
|---|---|---|---|---|---|---|---|---|---|
| Serum | CSF | CT (Low-density lesions) | MRI (Hyperintensity lesions on T2 FLAIR or T2-weighted) | ||||||
| 1 | 30/F | fever, flu-like symptoms, CD, convulsive seizure, decerebrate posture, LR (−/−), DTR ↓, BS (+/+) | Leukopenia, CRP↑, ALT/AST ↑ IL-6 ↑, VCAM-1 ↑ |
No pleocytosis, protein ↑, IgG index ↑ |
Bil. Th | Bil. Th, CWM, CM, BT; microbleeds on SWI | Anti-viral, Antimicrobials, PT, PP | Expired | our case |
| 2 | 80/M | fever, flu-like symptoms, CD, convulsive seizure, corneal reflex (−/−), VOR (−) | DIC, acute liver failure, Cr ↑ Inf B (+) IL-6 ↑ |
NA | Bil. Th | NA | Anti-viral, PT, IVIG |
Expired | [11] |
| 3 | 23/F | fever, flu-like symptoms, CD, decerebrate posture, LR (−), cornea reflex (−), DTR ↑ | Thrombocytopenia, ALT/AST ↑ | protein ↑ | NA | Bil. Th, brainstem, and cerebellum; Bil. Th hemorrhage on gradient sequence | Antimicrobials | Expired | [17] |
| 4 | 39/F | diarrhea, CD, decorticate rigidity, LR (−), BS(+) | LDH ↑, ALT/AST ↑ | No pleocytosis, protein ↑ | Bil. Th, basal ganglia, CWM, and brainstem | Bil. Th, basal ganglia, CWM, and brainstem | NA | Persistent vegetative state | [19] |
| 5 | 40/M | fever, diarrhea, flu-like symptoms, CD | LDH ↑, CRP↑, ALT/AST↑, thrombocytopenia, coagulopathy, Inf A-H1N1 (+) in nasopharyngeal swabs |
No pleocytosis, protein ↑ | Bil. Th, brainstem | Bil. Th and brainstem; microbleeds on gradient echo | Anti-viral, Antimicrobials | Little improvement | [20] |
| 6 | 27/F | flu-like symptoms, CD, LR (−), corneal reflex (−) | Inf A RT-PCR (+) | No pleocytosis, protein ↑ | diffuse cerebral white matter edema | Bil Th, CWM, CM, brainstem; microbleeds on gradient echo | Anti-viral | Expired | [13] |
| 7 | 76/F | fever, CD, corneal reflex (−/−), VOR (−), DTR ↓ | LDH ↑, CPK ↑, ALT/AST ↑ IL-6 ↑, IL-10 ↑ |
Lymphocytic pleocytosis, protein ↑, IL-6 ↑ | NA | Bil. Th, globus pallidus, caudate head, BT | PT, IVIG | Little improvement | [18] |
| 8 | 22/M | fever, CD | ALT ↑, Cr ↑ Inf A IgA (+) |
No pleocytosis, protein ↑ | NA | Bil. Th | Anti-viral, antimicrobials | Complete recovery | [9] |
| 9 | 24/F | fever, vomiting, diarrhea, CD, pathologic reflex (+) | thrombocytopenia, lactate ↑, ALT/AST ↑, Cr ↑, coagulopathy |
No pleocytosis protein ↑ | Bil. Th | Bil. Th, CWM, CM | Anti-viral | Mild cognitive disability | [12] |
| 10 | 27/M | fever, flu-like symptoms, CD, convulsive seizure, decerebrate rigidity, DTR ↑ | Inf A-H3N2 (+) | Neutrophilic pleocytosis, protein ↑ IL-1β ↑, IL-6 ↑ |
Bil. Th | Bil. Th, brainstem, and CWM | Anti-viral, PT | Wheelchair-bound | [10] |
| 11 | 20/F | fever, CD, right limbs convulsion, decerebrate posture, pupil dilation, LR (−), DTR ↓, BS (+/−) | ALT ↑ | NA | NA | Bil. Th, BT | Anti-viral, steroid, IVIG |
Left hemiparesis, personality change | [14] |
| 12 | 46/F | fever, CD, convulsion, DTR ↑, pathologic reflex (+) |
LDH ↑, γ-globulin↑ hypoalbuminemia | No pleocytosis protein ↑ | Bil. Th | Bil. Th | PT | Cognitive disability | [16] |
| 13 | 67/F | dysarthria, dysphagia, ataxia, nystagmus, painful paresthesia, CD, arms rigidly extended | abnormal liver function | Xanthochromic, protein ↑ | Bil. Th, brainstem, cerebellum | NA | NA | Expired | [15] |
Abbreviations: F: female; M: male; CD: disturbance of consciousness; LR: pupillary light reflex; DTR: deep tendon reflex; BS: Babinski sign; VOR: vestibulo-ocular reflex; CSF: cerebrospinal fluid; DIC: disseminated intravascular coagulation; CRP: C-reactive protein; LDH: lactate dehydrogenase; CPK: creatine phosphokinase; Cr: creatinine; Bil.: bilateral; Th: thalami; BT: brainstem tegmentum; CWM: cerebral white matter; CM: cerebellar medulla; NA: not available; T1(+): T1-weighted image post gadolinium enhancement; DWI: Diffusion-weighted images; SWI: Susceptibility weighted images; Anti-viral: Anti-viral agent; PT: steroid pulse therapy; PP: plasmapheresis; IVIG: Intravenous immunoglobulin.