Cerebral Magnetic Resonance Imaging Findings in Adults with Haemolytic Uraemic Syndrome Following an Infection with Escherichia coli, Subtype O104:H4

TY - JOUR

T1 - Cerebral Magnetic Resonance Imaging Findings in Adults with Haemolytic Uraemic Syndrome Following an Infection with Escherichia coli, Subtype O104:H4

AU - Löbel, U

AU - Eckert, B

AU - Simova, O

AU - Meier-Cillien, M

AU - Kluge, S

AU - Gerloff, C

AU - Röther, J

AU - Magnus, T

AU - Fiehler, J

PY - 2014/6/1

Y1 - 2014/6/1

N2 - PURPOSE: Infections with Enterohaemorrhagic Escherichia coli typically occur in children causing haemolytic uraemic syndrome (HUS) and neurological symptoms in 20-50 %. Little information is available on the morphology of brain manifestations in adults. The purpose of this study was to identify a characteristic magnetic resonance imaging (MRI) pattern during the outbreak of a novel mutation of Escherichia coli O104:H4.METHODS: Patients were recruited from two hospitals between May and July 2011. The MRI protocol included standard anatomical, diffusion-weighted, and susceptibility-sensitive sequences.RESULTS: A total of 104 MRIs of 57 (32 female, 25 male) patients (mean 45.5 ± 18.4 years) showed abnormal signal intensity on 51 MRIs (49 %). Bilateral thalamus (39 %), bilateral pons (35 %), centrum semiovale and splenium of corpus callosum (33 %) were most often involved. Acute lesions were reversible in 81 % of cases. There was no statistically significant association between symptom onset and the MRI findings (P = 0.2).CONCLUSIONS: Neuroimaging findings in this adult patient cohort were non-specific and similar to previous findings in children. A characteristic neuroimaging pattern of an infection with Escherichia coli O104:H4 was not identified. However, bilateral symmetric T2 hyperintense lesions of the thalami and dorsal pons characterized by restricted diffusion suggest a metabolic toxic effect of the disease on the brain.

AB - PURPOSE: Infections with Enterohaemorrhagic Escherichia coli typically occur in children causing haemolytic uraemic syndrome (HUS) and neurological symptoms in 20-50 %. Little information is available on the morphology of brain manifestations in adults. The purpose of this study was to identify a characteristic magnetic resonance imaging (MRI) pattern during the outbreak of a novel mutation of Escherichia coli O104:H4.METHODS: Patients were recruited from two hospitals between May and July 2011. The MRI protocol included standard anatomical, diffusion-weighted, and susceptibility-sensitive sequences.RESULTS: A total of 104 MRIs of 57 (32 female, 25 male) patients (mean 45.5 ± 18.4 years) showed abnormal signal intensity on 51 MRIs (49 %). Bilateral thalamus (39 %), bilateral pons (35 %), centrum semiovale and splenium of corpus callosum (33 %) were most often involved. Acute lesions were reversible in 81 % of cases. There was no statistically significant association between symptom onset and the MRI findings (P = 0.2).CONCLUSIONS: Neuroimaging findings in this adult patient cohort were non-specific and similar to previous findings in children. A characteristic neuroimaging pattern of an infection with Escherichia coli O104:H4 was not identified. However, bilateral symmetric T2 hyperintense lesions of the thalami and dorsal pons characterized by restricted diffusion suggest a metabolic toxic effect of the disease on the brain.

U2 - 10.1007/s00062-013-0231-0

DO - 10.1007/s00062-013-0231-0

M3 - SCORING: Journal article

C2 - 23811994

VL - 24

SP - 111

EP - 119

JO - CLIN NEURORADIOL

JF - CLIN NEURORADIOL

SN - 1869-1439

IS - 2

ER -