Abstract
Bilateral striatal necrosis in acute encephalopathy has been reported in a small number of adults with methanol or cyanide intoxication, hypoxic encephalopathy or haemolytic-uraemic syndrome. Acute encephalopathy with bilateral striatal necrosis has been reported in infants and children. However, the pathogenesis of the necrosis remains unclear. This is the first report of serial imaging from the very early to chronic stage in two acute encephalopathic adults with bilateral striatal necrosis. A clinicoradiological study is presented for clarification of the pathological process and pathogenesis. Striatal lesions were not detected in the very early stages, but only thereafter. Serial studies suggested that the lesions were caused by delayed neuronal death. These patients had severe lactic acidosis, near the limit for survival. There have been few reports of adults with acute encephalopathy and bilateral striatal necrosis in whom arterial pH was described; all these exhibited marked acidosis. The common pathophysiological condition among these encephalopathies with bilateral striatal necrosis could be lactic acidosis elicited by impairment of ATP generation through the Krebs cycle. The striatum might represent one of the target areas of Krebs-cycle blockade.
Similar content being viewed by others
References
Aquilonius S-M, Askmark H, Enoksson P, Lundberg PO, Moström U (1980) Computerised tomography in severe methanol intoxication. BMJ 30: 929–930
Kasamo K, Sato R, Takahashi S, Kojima T, Okuhata Y, Kamata R (1992) Basal ganglia damages after acute cyanide intoxiation (in Japanese). J Nihon Univ Med Ass 51: 973–976
Boylan KB, Chin JH, DeArmond SJ (1990) Progressive dystonia following resuscitation from cardiac arrest. Neurology 40: 1458–1461
Adams JH, Brierley JB, Connor RCR, Treip CS (1966) The effects of systemic hypotension upon the human brain: clinical and neuropathological observations in 11 cases. Brain 89: 235–265
Okada M, Okuda B, Okae S (1982) Bilateral necrosis of the pallidum in a case of carbon monoxide poisoning. Neurol Med (Tokyo) 17: 304–305
Hrynchak M, Ang LC, Munoz DG (1992) Bilateral striatal necrosis in hemolytic-uremic syndrome. Clin Neuropathol 11: 45–48
Roig M, Macaya A, Munell F, Capedevila A (1990) Acute neurologic dysfunction associated with destructive lesions of the basal ganglia: a benign form of infantile bilateral striatal necrosis. J Pediatr 117: 578–581
Gauthier M, Geoffroy G (1991) Infantile bilateral striatal necrosis. J Pediatr 119: 675
Aoki N (1992) Infantile acute encephalopathy with combined symmetrical hypodensities in the thalami and the putamen on computed tomography. Neurol Res 14: 252–254
Rosemberg S, Amaral LC, Kliemann SE, Arita FN (1992) Acute encephalopathy with bilateral striatal necrosis. A distinctive clinicopathological condition. Neuropediatrics 23: 310–315
Sola Martínez, Pierot L, Noseda G, Martin-Duverneuil N, Harpey JP, Roy C, Chiras J (1994) Acute bilateral striatal necrosis in an infant: CT and MRI. Neuroradiology 36: 245–246
Brierley JB (1975) Comparison between effects of profound arterial hypotension, hypoxia, and cyanide on the brain of Macaca mulatta. Adv Neurol 10: 213–221
Medina L, Chi TL, De Vivo DC, Hilal SK (1990) MR findings in patients with subacute necrotizing encephalomyelopathy (Leigh syndrome): correlation with biochemical defect. AJNR 11: 379–384
Egger J, Kendell BE (1981) Computed tomography in mitochondrial cytopathy. Neuroradiology 22: 73–78
Hall K, Gardner-Medwin D (1978) CT scan appearances in Leigh's disease (subacute necrotizing encephalomyelopathy) Neuroradiology 16: 48–50
Williams FJB, Walshe JM (1981) Wilson's disease. An analysis of the cranial computed tomographic appearances found in 60 patients and the changes in response to treatment with chelating agents. Brain 104: 735–752
Gascon GG, Ozand PT, Brismar J (1994) Movement disorders in childhood organic acidurias. Clinical, neuroimaging, and biochemical correlations. Brain Dev 16 [Suppl]: 94–103
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Kamei, S., Takasu, T., Mori, N. et al. Serial imaging of bilateral striatal necrosis associated with acidaemia in adults. Neuroradiology 38, 437–440 (1996). https://doi.org/10.1007/BF00607268
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF00607268