Wallach's Interpretation of Diagnostic Tests: Pathways to Arriving at a Clinical Diagnosis (85 page)

The syndrome occurs typically in children recovering from influenza, varicella, or nonspecific viral illness and is associated with the use of aspirin. Reye syndrome presents with nausea, vomiting, headache, and delirium with frequent progression to coma. Since aspirin was identified as a major precipitating factor for the development of Reye syndrome, this complication has virtually disappeared.
¹
The differential diagnosis includes sepsis, meningitis, brain tumor, and intracranial hemorrhage and in small children shaken baby syndrome. Imaging studies should be undertaken to rule out intracranial hemorrhage or mass and sinus thrombosis.

   Laboratory Findings

   The diagnostic criteria for Reye syndrome include a markedly increased CSF pressure with no other abnormalities.

   Screening tests to eliminate other etiologies include CBC, glucose, electrolytes, BUN, creatinine, calcium, magnesium, and phosphate.

   Serum AST, ALT, or ammonia may be three times greater than the upper limit of normal.

   On biopsy of the liver, noninflammatory, panlobular fatty changes are seen.

Reference

1.  Belay ED, Bresee JS, Holman RC, et al. Reye’s syndrome in the United States from 1981 through 1997.
N Engl J Med.
1999;340:1377.

SEIZURES

   Definition

Seizures represent a sudden change in behavior as a result of brain dysfunction.

   Clinical Presentation

Patients present in one of three major groups:
epileptic
(resulting from electrical hypersynchronization of neuronal networks in the cerebral cortex),
provoked
(resulting from metabolic abnormality, drug or alcohol withdrawal, and acute illness or neurologic disorders such as stroke), and
nonepileptic
events (imitators of epilepsy such as syncope, psychological disorders, migraine, and transient ischemic attack).

Conditions associated with seizure activity include the following:

   Brain tumors, abscess, and space-occupying lesions

   Circulatory disorders such as thrombosis, hemorrhage, embolism, hypertensive encephalopathy, vascular malformations, and angiitis

   Hematologic disorders such as sickle cell anemia, leukemia, and TTP

   Metabolic abnormalities such as DM, hyperthyroidism

   Porphyria, eclampsia, and renal failure