Abstract：
INTRODUCTION:The underlying pathophysiology of neurological complications in patients with hemolytic-uremic syndrome (HUS) remains unclear. It was recently attributed to a direct cytotoxic effect of Shiga toxin 2 (Stx2) in the thalamus. Conventional MRI of patients with Stx2-caused HUS revealed - despite severe neurological symptoms - only mild alterations if any, mostly in the thalamus. Against this background, we questioned: Does diffusion tensor imaging (DTI) capture the thalamic damage better than conventional MRI? Are neurological symptoms and disease course better reflected by thalamic alterations as detected by DTI? Are other brain regions also affected? METHODS:Three women with serious neurological deficits due to Stx2-associated HUS were admitted to MRI/DTI at disease onset. Two of them were longitudinally examined. Fractional anisotropy (FA) and mean diffusivity were computed to assess Stx2-caused microstructural damage. RESULTS:Compared to 90 healthy women, all three patients had significantly reduced thalamic FA. Thalamic mean diffusivity was only reduced in two patients. DTI of the longitudinally examined women demonstrated slow normalization of thalamic FA, which was paralleled by clinical improvement. CONCLUSION:Whereas conventional MRI only shows slight alterations based on subjective evaluation, DTI permits quantitative, objective, and longitudinal assessment of cytotoxic cerebral damage in individual patients.
journal_name
J Neurol Scijournal_title
Journal of the neurological sciencesauthors
Krämer J,Deppe M,Göbel K,Tabelow K,Wiendl H,Meuth SGdoi
10.1016/j.jns.2015.06.045subject
Has Abstractpub_date
2015-09-15 00:00:00pages
175-83issue
1-2eissn
0022-510Xissn
1878-5883pii
S0022-510X(15)00386-Xjournal_volume
356pub_type
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