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The mortality from and/or incidence of neurological sequelae of childhood acute encephalopathies, including Reye's syndrome, influenza encephalopathy and acute necrotizing encephalopathy, are still high. We have already reported that mild hypothermia therapy facilitates excellent recovery from acute encephalopathy. The purpose of this study was to investigate the usefulness of transcranial Doppler sonography (TCD) as a nonintensive care technique for severe acute encephalopathy during mild hypothermia therapy. The subjects comprised 12 children with acute encephalopathy: nine boys and three girls. The mean age of the patients was 4.6±4.56 (mean±standard deviation), ranging from 1 year 8 months to 15 years 3 months. The etiologies of acute encephalopathy were thought to be influenza-related in 8 patients, varicella in one, and unknown in the remaining three. They were evaluated and treated at Nihon University Itabashi Hospital during a 7-year period (1993 to 1999) . We used TCD (TC2-64, EME) for bedside monitoring, and evaluated the PI (pulsatility index, Gosling 1974) of the MCA and ACA at three points during therapy (before, during and after hypothermia) . The PI of the MCA and ACA was significantly higher before hypothermia than during and after hypothermia (p<0.01) . There were no significant changes in the PI during and after hypothermia. In the group showing excellent recovery, the PI fell on the day after the start of hypothermia therapy. On the other hand, in the poor outcome group, the PI rose on the day after the start of hypothermia therapy. Thus we were able to decide the timing of the rewarming point using TCD. TCD is useful for bedside monitoring in children with severe acute encephalopathies.
日本脳神経超音波学会の論文

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