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Cerebral Magnetic Resonance Imaging Findings in Adults with Haemolytic Uraemic Syndrome Following an Infection with Escherichia coli, Subtype O104:H4

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Abstract

Purpose

Infections with Enterohaemorrhagic Escherichia coli typically occur in children causing haemolytic uraemic syndrome (HUS) and neurological symptoms in 20–50 %. Little information is available on the morphology of brain manifestations in adults. The purpose of this study was to identify a characteristic magnetic resonance imaging (MRI) pattern during the outbreak of a novel mutation of Escherichia coli O104:H4.

Methods

Patients were recruited from two hospitals between May and July 2011. The MRI protocol included standard anatomical, diffusion-weighted, and susceptibility-sensitive sequences.

Results

A total of 104 MRIs of 57 (32 female, 25 male) patients (mean 45.5 ± 18.4 years) showed abnormal signal intensity on 51 MRIs (49 %). Bilateral thalamus (39 %), bilateral pons (35 %), centrum semiovale and splenium of corpus callosum (33 %) were most often involved. Acute lesions were reversible in 81 % of cases. There was no statistically significant association between symptom onset and the MRI findings (P = 0.2).

Conclusions

Neuroimaging findings in this adult patient cohort were non-specific and similar to previous findings in children. A characteristic neuroimaging pattern of an infection with Escherichia coli O104:H4 was not identified. However, bilateral symmetric T2 hyperintense lesions of the thalami and dorsal pons characterized by restricted diffusion suggest a metabolic toxic effect of the disease on the brain.

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Conflict of Interest

The authors declare that there are no actual or potential conflicts of interest in relation to this article.

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Authors and Affiliations

  1. Department of Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany

    U. Löbel & J. Fiehler

  2. Department of Neuroradiology, Asklepios Klinik Altona, Paul-Ehrlich-Straße 1, 22763, Hamburg, Germany

    B. Eckert

  3. Department of Neurology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany

    O. Simova, C. Gerloff & T. Magnus

  4. Department of Neurology, Asklepios Klinik Altona, Paul-Ehrlich-Straße 1, 22763, Hamburg, Germany

    M. Meier-Cillien & J. Röther

  5. Department of Intensive Care, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany

    S. Kluge

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  1. U. Löbel
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  2. B. Eckert
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  3. O. Simova
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  4. M. Meier-Cillien
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  5. S. Kluge
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  6. C. Gerloff
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  7. J. Röther
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  8. T. Magnus
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  9. J. Fiehler
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Correspondence to J. Fiehler.

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Löbel, U., Eckert, B., Simova, O. et al. Cerebral Magnetic Resonance Imaging Findings in Adults with Haemolytic Uraemic Syndrome Following an Infection with Escherichia coli, Subtype O104:H4. Clin Neuroradiol 24, 111–119 (2014). https://doi.org/10.1007/s00062-013-0231-0

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  • DOI: https://doi.org/10.1007/s00062-013-0231-0

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