CT scan abnormalities in a series of patients with hemorrhagic shock and encephalopathy syndrome

Background. Hemorrhagic shock and encephalopathy syndrome (HSES) affects children under 1 year of age and is characterized by seizures, shock and certain laboratory abnormalities, including coagulation abnormalities. It has a high mortality and many of the survivors are neurologically abnormal. Objective. To describe abnormalities observed on initial and follow-up CT scans in a group of patients suffering from HSES. Materials and methods. Retrospective review of records and CT scans of ten patients with HSES who were admitted to the intensive care unit of the Children's Hospital and Medical Center, Seattle. Results. Cerebral edema was seen in all cases when the CT scan was obtained between 1 and 7 days after onset of HSES. The basal ganglia and cerebellum were relatively spared, and no hemorrhage was seen. Patients with moderate or marked cerebral edema usually had a poor prognosis. All survivors had significant neurologic sequelae. CT scans obtained after 7 days often showed encephalomalacia with ex vacuo ventricular enlargement. CT scans obtained between 24 h and 4 days after onset will show the acute changes of HSES. CT scans during the initial and convalescent stages of HSES can provide useful information about cerebral edema and encephalomalacia, which occur frequently with this illness. (orig.). With 4 figs., 2 tabs