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Hemorrhagic shock and encephalopathy syndrome is a devastating disease, but the pathogenesis remains unclear. The aim of this study was to examine the usefulness of neuroimaging in establishing a diagnosis and elucidating the pathogenesis. We analyzed the neuroradiologic features of 22 patients who fulfilled the Levin criteria. All patients underwent brain computed tomography (CT), and 14 patients underwent brain magnetic resonance imaging (MRI) including diffusion-weighted imaging in 10 patients. Initial CT showed normal findings in 14 of 18 (78%) patients, but subsequently hypodensities appeared in bilateral watershed zones and progressed to whole brain edema. MRI revealed cytotoxic edema, showing hyperintensities in bilateral watershed zones on diffusion-weighted imaging with a low apparent diffusion coefficient. Serial neuroimaging showed characteristic features of a widespread brain ischemic event mainly in watershed zones in hemorrhagic shock and encephalopathy syndrome. [ABSTRACT FROM AUTHOR]

One approach to studying pediatric stroke is to analyze a national database that contains data on a significant number of children. We examined an administrative dataset of hospital discharges from the United States, Kids' Inpatient Database 2003 (KID2003), for ICD-9 codes associated with hemorrhagic or ischemic stroke in children aged >30 days to 20 years. 3156 children were discharged with a diagnosis of ischemic stroke and 2022 with hemorrhagic stroke after statistical weighting. The odds for a male discharged with hemorrhagic stroke was 1.5 (CI: 1.35-1.68) and for ischemic stroke was 1.37 (CI: 1.24-1.51) compared with a female. The odds for males discharged with a stroke were greatest for ages 16 to 20 years and least for 4 years. This study confirms a male predominance for stroke. The odds for hospitalization with a stroke diagnosis are greatest in very young and older adolescent males. Hemorrhage is an important stroke subtype in children. [ABSTRACT FROM AUTHOR]

The syndrome of hemorrhagic shock and encephalopathy is associated with an acute onset of diarrhea, followed by shock, disseminated intravascular coagulopathy, multiorgan failure, and encephalopathy. The etiology of this syndrome is unknown, and despite intensive treatment, the outcome is often fatal or associated with severe neurological sequelae. Two infants aged 6 and 9 months were admitted with this syndrome within a 24-hour time interval. The authors hereby present the clinical course and a prospective evaluation of the neurological outcome. A review of the literature regarding this infrequent syndrome is presented. [ABSTRACT FROM AUTHOR]