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Journal Article Ahead of print

PubMed: 42447646 DOI: 10.1016/j.braindev.2026.104572

Associations between patterns of diffusion-weighted magnetic resonance imaging and long-term outcomes in acute encephalopathy with biphasic seizures and late reduced diffusion.

Brain Dev 48(4):104572

Authors: Ikko Ohshiro, Daerhan Buranbai, Tohru Okanishi, Yoshihiro Maegaki

Affiliations

  • Division of Child Neurology, Department of Brain and Neurosciences, Faculty of Medicine, Tottori University, 36-1 Nishi-cho, Yonago, Tottori 683-8504, Japan; Division of Pediatrics, Gifu municipal Hospital, 7-1 Kashima-cho, Gifu, Gifu 500-8513, Japan.
  • Division of Child Neurology, Department of Brain and Neurosciences, Faculty of Medicine, Tottori University, 36-1 Nishi-cho, Yonago, Tottori 683-8504, Japan.
  • Division of Child Neurology, Department of Brain and Neurosciences, Faculty of Medicine, Tottori University, 36-1 Nishi-cho, Yonago, Tottori 683-8504, Japan.

Abstract

BACKGROUND

Acute encephalopathy with biphasic seizures and late reduced diffusion (AESD) is a common pediatric acute encephalopathy characterized by biphasic seizures and development of a bright tree appearance (BTA) on diffusion-weighted MR imaging (DWI). Lesion extent and distribution have been linked to neurological prognosis, but the effects of lesion depth remained unclear.

METHODS

We retrospectively analyzed 25 children with AESD onset between 1991 and 2022. Acute-phase magnetic resonance imaging (MRI) (4-14 days after onset) was evaluated using DWI. Lesions in 10 cerebral regions were classified by depth as BTA limited to the subcortical area (BTA-L) or BTA with extension into the deep white matter (BTA-E). Neurological outcomes included pediatric cerebral performance category scores and residual motor paralysis at ≥12 months. Associations between MRI findings and outcomes were analyzed using univariate logistic regression and receiver operating characteristic analyses.

RESULTS

Thirteen patients had favorable outcomes, whereas 12 had unfavorable outcomes based on pediatric cerebral performance category scores. Bilateral temporal lobe involvement with BTA-L/E (odds ratio [OR], 16.8), bilateral frontal lobe involvement with BTA-E (OR, 10.0), and bilateral thalamus/basal ganglia lesions (OR, 12.0) showed significant associations with unfavorable outcomes. Residual motor paralysis was associated with lesion burden and distribution. Rolandic BTA-E showed an association with motor paralysis (OR, 90.0), even in unilateral cases. This study should be considered exploratory due to the small sample size and the lack of adjustment for multiple comparisons.

CONCLUSIONS

Acute-phase MRI findings in AESD were associated with long-term neurological outcomes. Lesion distribution and deep white matter extension may serve as potential prognostic factors. Frontal BTA-E and Rolandic BTA-E were associated with cognitive impairment and motor paralysis, respectively.

MeSH

White Matter, Brain, Magnetic Resonance Imaging, Child Development, Brain Diseases, Seizures, Pediatrics, Nervous System Diseases, Paralysis, Prognosis