M Reyes Syndrome

Reye's syndrome manifests with the development of lethargy, irritability, and progressive obtundation in children and young adults following viral infections. The neurologic symptoms have been attributed to diffuse cytotoxic edema documented at autopsy. The

Figure 10 Cytotoxic edema of fulminant hepatic failure illustrated by DWI hyperintensity in (a) bilateral thalami and (b) bilateral frontal cortices. Diffuse vasogenic edema is demonstrated (c) by CT 3 days later.

Figure 11 Diffuse cerebral edema with swollen gyri and focal cortical contusion (arrow) noted at autopsy. (Courtesy of Harry V. Vinters, M.D.)

pathogenesis of this syndrome revolves around the associated hepatic impairment. Toxic effects related to fatty infiltration of the liver and elevated serum ammonia are suspect. Aspirin therapy for fever due to influenza and other viral infections are also implicated as precipitating factors, although the underlying pathophysiology is uncertain.

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